| Objective: The prognosis of radical surgical treatment for patients with non-small cell lung cancer is affected by the degree of lymph node metastasis.In this paper,we analyze the clinical characteristics of the pattern of lymph node metastasis and further investigate the lymph node clearance modalities for surgical treatment of lung nodes with different characteristics.Methods: To retrospectively analyze the inpatient data of 233 patients with primary c TNM-stage IA NSCLC from January 1,2020 to June 1,2021 in the Department of Thoracic Surgery of The First Affiliated Hospital of Bengbu Medical College,including general basic information,preoperative examination of chest CT tumor diameter,solid tumor components,and tumor and lymph node pathology after undergoing lobectomy and systemic lymph node dissection.To summarize and analyze the influencing factors related to lymph node metastasis and the pattern of lymph node metastasis,and further combine with clinical practice to propose different lymph node dissection recommendations for lung nodes with different characteristics.Result: A total of 3145 lymph nodes were obtained in 233 patients,with an average of13.5 lymph nodes per case,and 440 lymph nodes had cancer metastasis,with a metastasis rate of 14.0%.49 of 233 patients had intrathoracic lymph node metastasis,including 16 cases of N1,25 cases of N1+N2 [Note: N1: metastasis of intrapulmonary lymph nodes（intrapulmonary group 10-14 lymph nodes）alone;N1+N2: metastasis of N2（mediastinal group 2-9 lymph nodes）was also present.N1+N2: N2（mediastinal lymph nodes of groups 2-9）and N1（intrapulmonary lymph nodes of groups 10-14）metastases existed at the same time],and jumping N2（intrapulmonary lymph nodes of groups 10-14）metastases existed in 8 cases,with a metastasis rate of 21.0%.Among them,10 cases（62.5%）had positive group 10 lymph nodes in N1,and 18 cases（72.0%）had positive group 10 lymph nodes in N1+N2.Among 233 cases of non-small cell carcinoma,the lymph node metastasis rates in T1 a,T1b,and T1 c were 14.1%,18.9%,and 77.8%,respectively.The lymph node metastasis rate was statistically significant between T1 a and T1b（P < 0.05）,but not between T1 b and T1c（P > 0.05）.the probability of regional lymph node metastasis in T1 b stage was significantly higher than that in T1 a stage,and the regional lymph node metastasis rate of non-small cell carcinoma showed a positive correlation with the size of the tumor.Lymph node metastasis was also different for different nodal properties,and the rates of lymph node metastasis occurred in pure GGN,GGN-dominant,solid component-dominant,and pure solid nodes were 0,0,25.0%,and51.5%,respectively,and the differences in lymph node metastasis rates among the four groups by statistical analysis were statistically significant（χ~2= 61.925,P<0.01）,indicating that the lymph node metastasis rate of lung nodes with different interval CTR metastasis rate increases with the increase of the solid component.By regression analysis of CTR,the area under the curve for CTR predicting positive lymph nodes was 0.843（95%CI 0.810-0.876,P<0.001）,with a sensitivity of 100.0% and specificity of 68.1% when the cut-off value was 0.80.The difference in the rate of lymph node metastasis in group10 was statistically significant between stage T1 b and T1a（P < 0.05）,and the rate of metastasis of lymph nodes in group 10 was 25.9% and 8.3% in poorly and moderately differentiated lung cancer,respectively（χ 2= 9.06,P < 0.05）.Conclusions:1,In patients with stage T1 a NSCLC,lymph node metastasis rate is very low and the proportion of solid component is less than 0.8 can be considered without lymph node dissection.2、In patients with stage T1 b NSCLC,if the proportion of solid component is less than0.8,LSLD can be considered if it is clear that the hilar lymph nodes are non-metastatic lymph nodes.3、In patients with stage T1 c NSCLC,if the proportion of solid component is greater than0.8,if it is clear that the hilar lymph nodes are metastatic lymph nodes,SMLD should be performed. |
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