Influential Factor Of Cervical Lymph Node Metastasis In Lung Cancer

Objective:Analysis the relationship between the location of tumor,size of carcinoma, pathological classification and cervical lymph nodemetastasis in lung cancer,to investigate the metastatic patterns.Method:Collected206cases from2004to2010for the first timetreated in The Fourth Hospital of Hebei Medical University, who withconstitutional lung cancer and regional lymph node metastasis. Male143cases, female63cases; median age was61.5.126cases with definitepathological classification:50cases with adenocarcinoma,49cases withsquamous cell carcinoma,27cases with small cell cancer. Among allpatients44cases in left upper lobe,34cases in left lower,61cases inright upper,31cases right middle and36cases in right lower lobe.139cases with central cancer, the other67cases with peripheral cancer. Themaximum tumor diameter≤3cm was78cases,>3cm was128cases.Patients were staged according to TNM staging criteria of the WorldHealth Organization for lung cancer(1997), T1:34cases, T2:112cases,T3:26cases and T4:34cases; N1:3cases,N2:53cases, N3:150cases; M0:160cases, M1:46cases. According to Som etc. neck imageareal divison cervical lymph node was divided into five regions includingupper mediastinal lymph nodes (I), organs lymph nodes (Ⅱ), cervicallymph nodes (Ⅲ), cervical lymph nodes (IV), posterior triangle lymphnodes (Ⅴ).SPSS13.0statistical software was used for statistical analysis,group compared using the χ~2test, P <0.05was considered statisticallysignificant.Results:1Distribution of cervical lymph node metastasisThe cases of cervical lymph node metastasis in112cases, accounting for54.4%(112/206) of the whole group.The metastasis rateof cervical region were Ⅲ:78.6%(88/112), I:69.6%(78/112), IV:64.3%(72/112),Ⅱ:24.1%(27/112), Ⅴ:23.2%(26/112). III, I, IVwere higherthan Ⅱ, Ⅴ (P=0.000).The right cervical lymph node metastasis rate was86.6%(97/112),higher then60.7%(68/112) in the left. The lymph node metastasis rate ineach right region was higher than that in left: ⅠR:65.2%(73/112) vsⅠL:16.1%(18/112),ⅡR18.8%(21/112)vsⅡL8.9%(10/112),ⅢR57.1%(64/112)vsⅢL52.7%(59/112),ⅣR50.9%(57/112)vsⅣL31.3%(35/112),ⅤR15.2%(17/112)vsⅤL13.4%(15/112)(P=0.000,P=0.033,P=0.502,P=0.003,P=0.703).2The location of tumor with cervical lymph node metastasisThe cervical lymph node metastasis rate in peripheral lung cancergroup and central lung cancer group were56.7%(38/67) and53.2%(74/139),(P=0.639).In the two groups, the metastasis rate of rightcervical was higher than left,［28.6%(32/112) vs21.4%(24/112),58.0%(65/112) vs39.3%(44/112)(P=0.037,P=0.000)］.The metastasis rate of left lung cancer group was60.3%(47/78)higher than the right one witch was50.8%(65/128),(P=0.185). Theright and the left cervical metastasis rate of left lung cancer group were33.9%(38/112),28.6%(32/112)(P=0.156). In righter lung cancer groupwere52.7%(59/112),31.3%(35/112),(P=0.000).The metastasis rate in upper lobe of lung was61.0%(64/105),higher than the middle lobe and the lower lobe51.6%(16/31),45.7%(32/70)(P=0.132). In each lobe,the metastasis rate of right cervical washigher than the left,[48.2%(54/112) vs34.8%(39/112),13.4%(15/112)vs8.0%(9/112),25.0%(28/112) vs17.9%(20/112)(P=0.003,P=0.014,P=0.021)].In left upper lobe lung cancer group, the lymph node metastasis rateof right and left cervical were21.4%(24/112) and20.5(23/112)(P=0.777); in left lower lobe group,the metastasis rate was12.5%(14/112) and8.0%(9/112)(P=0.031); in right upper lobe group was25.9%(29/112) vs13.4%(15/112),(P=0.000); in right middler lobe group was14.3%(16/112) vs8.9%(10/112),(P=0.007); in right middler lobe groupwas12.5%(14/112) vs8.9%(10/112),(P=0.132).3Pathological classification with cervical lymph node metastasisThe cervical lymph node metastasis rate of adenocarcinoma, smallcell carcinoma and squamous cell carcinoma were90%(45/50),81.5%(22/27),61.2%(30/49). The adenocarcinoma group was higher than thesquamous cell carcinoma one (P=0.001). The metastasis rate of right andleft cervical in the three groups were35.7%(40/112) vs24.1%(27/112),15.2%(17/112) vs12.5%(14/112),25.0%(28/112) vs14.3%(16/112),(P=0.002,P=0.322,P=0.000). And the lymph nodes were all focus onⅠ,Ⅲ,Ⅳof cervical in the three groups.4The size of tumor with cervical lymph node metastasisThe cervical lymph node metastasis rate of the group with maximumtumor diameter>3cm was56.6%(69/128), and≤3cm group was51.2%(43/84),(P=0.447).The metastasis rate of right and left cervical in thetwo groups was50.0%(56/112) vs36.6%(41/112) and36.6%(42/112)vs24.1%(27/112),(P=0.005,P=0.000).Conclusion:1.Cervical lymph node metastases were112cases, accounting for54.4%(112/206) of the total number of206cases, the metastases rate ishigher.2.Cervical regionⅠ,Ⅲ,Ⅳhad a higher rate of metastasis.3.The right cervical lymph node metastasis rate was higher than theleft. The left lower lobe, right upper lobe and the right middle lobe withhigher metastasis rate to the right cervical than to the left cervical.4.Adenocarcinoma had higher metastasis rate of cervical lymphnode than squamous cell carcinoma.5. The relationship between the cervical lymph node metastasis andthe size of tumor,the location of tumor (peripheral lung cancer, central lung cancer；upper,middle,lower lobe cancer) requires further study.