| OBJECTIVE To investigate the relationship between the possible influence factors of non-small cell lung cancer(NSCLC)and the metastases of mediastinal lymph node(MLN)in different tumor locations,tumor diameters,biological behaviors of different pathological types,differentiation and tumor markers.It is assessing the possible risk factors judging the characteristics and rules of chest lymph node metastasis to provide a certain reference for the non-systematic lymph node dissection.METHODS A total of 176 patients with non-small cell lung cancer who underwent surgical resection were collected from the Second Hospital of Lanzhou University from January 2014 to December 31,2017.The baseline information of the investigators was included in the statistics,and the metastasis rate at each site was analyzed.The characteristics of lymph node metastasis in each mediastinal region were analyzed,and the difference between upper and lower lobe tumor metastasis in each mediastinal lymphatic zone was compared using the chi-square test.Univariate analysis was performed on possible risk factors that were performed Logistic multivariate analysis if there was a significant difference.RESULTS Among the 176 NSCLC patients undergoing surgery,a total of 3309 lymph nodes were removed from the 1017 group of intrathoracic lymph nodes.An average of 18.8 lymph nodes were removed from each of the 5.78 patients and 279 lymph nodes from 135 positive N1/N2 nodes were metastasized.It accounted for 13.3% of the total dissected group(135/1017)and 8.4% of the total number of dissected lymph nodes(279/3309).The metastasis rate of each lobe was up to 54.5%(18/33)in the lower lobe of the right lung.The lymph nodes that most frequently appeared in each lobe were different.The upper right lobe had more than 10,N1,4R,and 2R,and the right lung was lower.There were more than 10,N1,7 and lower MLN in leaves,and 10,N1,7 and 4L in the left upper lobe,and 10,N1 and 7 in the left lower lobe.In the primary lobe of each tumor,the lymph node metastasis rate in N1 was significantly higher than that in other sites.In the lymph nodes of the mediastinum,the rate of lymph node metastasis in the subcarinal region was the highest 34.6%(27/78).The ratio of lymph nodes in the inferior mediastinum of the right upper lobe was lower than that of the right lobe(P=0.001).The left side contrast was similar(P=0.002).Univariate and multivariate analysis found that the risk factors for metastasis of MLN included adenocarcinoma of pathology type [OR=0.398,95%(0.211,0.751),P=0.001],and low degree of differentiation [OR=0457,95%(0.270,0.776),P=0.004],central lung cancer [OR=3.746,95%(1.434,9.762),P=0.007],larger tumor diameter [OR=1.157,95%(0.994,1.346),P=0.05];risk factors for lymph node metastasis in lower mediastinum The larger the tumor diameter [OR=1.367,95%(1.144,1.635),P=0.001],the tumor originated in the lower lobe [OR=3.647,95%(1.864,8.358),P=0.029],low degree of differentiation [OR=0.521,95%(0.29,0.935),P=0.029].The incidence of S-N2 in NSCLC patients with adenocarcinoma was high,but the difference was not statistically significant.CONCLUSIONS The metastatic pattern of mediastinal lymph node in different primary tumor lobes is different.The metastasis rate of subcarinal lymph nodes in each lobe is high,which is an important site for mediastinal lymph node dissection.Skipping lymph node metastasis can occur in each all primary site,especially for central tumors.The more the four risk factors are satisfied,the more likely it is that mediastinal lymph node metastasis occurs,and the non-systematic lymph node dissection is prudent.Metastasis of mediastinal lymph node in patients with NSCLC is closely related to tumor diameter.OBJECTIVE With the improvement of national living standards and the application of high-precision large-scale imaging equipment,the detection rate of some early stage non-small cell lung cancers has gradually increased.However,T1 and T2 NSCLC patients with p N2 have better prognosis with radiochemotherapy or induction chemotherapy.It is always argued whether PET/CT or mediastinoscopy should be used to obtain better mediastinal staging for CT scan-negative patients with T1-T2 stage.Therefore,this study will find out the independent risk factors affecting the occurrence of mediastinal lymph node metastasis in NSCLC patients and establish a mathematical model of risk prediction to assess the prior probability of their N2 disease to guide clinical better management of patients with NSCLC.METHODS We retrospectively collected 88 patients with non-small cell lung cancer who had been diagnosed with c T1-T2N0M0 and had undergone surgical treatment between January 2014 and December 31,2017.Lymph node metastasis was divided into the mediastinal lymph nodes region and subcarinal lymph nodes region and the inferior mediastinum lymph nodes region.Univariate and logistic multivariate regression analysis was performed on the lymph node metastasis in the threecomponent zone to explore possible influencing factors.Risk factors with statistically significance were established to predict the mathematical model and HosmerLemeshown(HL)was used to predict the fitness of the prediction equation,and the accuracy of the prediction model was calculated by calculating the area under receiver operating characteristic(ROC),and four table methods were used reverify.RESULTS A total of 88 patients with cT1-T2N0M0 stage NSCLC were enrolled and the incidence of N2 was 21.6%(19/88).The calculated risk factors for lymph node metastasis in the mediastinal region included tumor diameter,pathological type,lung cancer type(central or peripheral),and degree of differentiation.The HL test of the prediction model was P=0.852,ROC AUC was 0.76,95% CI(0.588,0.824),P=0.001,the four tables verified that the accuracy is 86.63%,the negative predictive value is 90.74%,the positive predictive value is 50.00%,the sensitivity is 20.00%,and the specificity is 97.35%.The three risk factors for lymph node metastasis in the inferior mediastinum were: tumor diameter,degree of differentiation,location of the primary lobe of the tumor,HL test of the prediction model P=0.836,ROC AUC 0.875,95% CI(0.800,0.951),P< 0.0001.Four tables confirmed its diagnostic accuracy: 94.31%;negative predictive value: 96.38%;positive predictive value: 60.00%;sensitivity(true positive rate): 50.00%;specificity(true negative rate): 97.56%.CONCLUSION The risk factors for mediastinal lymph node metastasis in c T1-T2N0 stage NSCLC are different from those in the inferior mediastinum.The common risk factors are tumor diameter and differentiation.The mediastinal lymph node metastasis is related to the location of the primary lobe.The probability of metastasis of the mediastinal lymph node is very low in patients with early NSCLC originating in the upper lobe.Therefore,the early stage NSCLC originating in the upper lobe is feasible to perform L-SMLD if without the upper mediastinum and subcarinal lymph node metastasis.The mediastinal lymph node metastasis rate in the early stage of primary NSCLC originating in the upper lobe is higher,and L-SMLD should be performed conservatively.The larger of predicted value of this model is,the greater the probability of metastasis of the corresponding regional lymph nodes is.Thus this mode can be used as a reference for clinicians for further mediastinal lymph node staging.For patients with lower predictive values,complete surgical excision of the lung tumor was performed without surgical contraindications,and lobe-specific lymph node dissection can be performed if rapidly freeze confirmed the absence of lymph node metastasis during the operation. |
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