| Objective :A retrospective analysis was conducted of the clinical data of patients with synchronous multiple primary lung cancer who were hospitalized in Yunnan Hospital from January 2015 to December 2021,to explore the characteristics of lymph node metastasis in patients with synchronous multiple primary lung cancer undergoing selective lymph node dissection,and to analyze the factors affecting lymph node metastasis.To explore whether selective lymph node dissection and lymph node sampling in patients with synchronous multiple primary lung cancer are beneficial for optimizing parameters of postoperative clinical indicators(postoperative hospital stay,surgical duration,intraoperative blood loss,total drainage volume of thoracic canal,retention time of thoracic canal,and postoperative complications),promoting rapid postoperative recovery of patients,and whether there are differences in prognosis.Methods:1.According to the case inclusion criteria and exclusion criteria,392 patients with synchronous multiple primary lung cancer who were hospitalized in Yunnan Cancer Hospital from January 2015 to December 2021 were selected,and their clinical data were collected and followed up.2.Spss 26.0 statistical software was used to analyze the collected clinical data.In the first part,a univariate analysis was conducted on the clinical characteristics of 167 patients with synchronous multiple primary lung cancer who underwent selective lymph node dissection,including gender,age,smoking history,tumor family history,tumor indicator CEA level,preoperative lymph node involvement,tumor location,maximum tumor size,sum of the length and diameter of each tumor,tumor number,tumor histopathological type,and lymph node metastasis,The relevant factors related to lymph node metastasis of synchronous multiple primary lung cancer were obtained,and then these factors were included in binary logistic regression analysis to obtain the factors affecting lymph node metastasis.In the second part,the general clinical characteristics and postoperative clinical indicators of patients with synchronous multiple primary lung cancer undergoing selective lymph node dissection and lymph node sampling were analyzed,including postoperative hospital stay,surgical duration,intraoperative blood loss,total drainage volume of thoracic canal,retention time of thoracic canal,and postoperative complications.The differences in postoperative clinical indicators and prognosis between the two groups of patients were compared.p<0.05 is statistically significant.Results:Among 392 patients with synchronous multiple primary lung cancer,167 underwent selective lymph node dissection,and 225 underwent lymph node sampling.Among the patients with synchronous multiple primary lung cancer undergoing selective lymph node dissection,there were 19 cases with positive lymph node metastasis and 148 cases with negative lymph node metastasis.In this study,The majority of patients with synchronous multiple primary lung cancer were female,non Xuanwei nationality,no smoking history,no family history,2 tumors,the maximum tumor length ≤ 2cm,all tumors located on the right side,all of them were adenocarcinoma,negative lymph node metastasis,lymph node sampling,lobar+wedge resection treatment,without adjuvant treatment after surgery.Male,carcinoembryonic antigen(CEA)level ≥ 5 ng/ml,preoperative hilar mediastinal lymph node maximum short diameter ≥ 1cm,maximum tumor length diameter>2 cm,The sum of the length and diameter of each tumor>3cm,and tumor imaging characteristics(all solid)were associated with lymph node metastasis in synchronous multiple primary lung cancer(p<0.05).In the selective lymph node dissection group,patients with a maximum tumor length>2cm and Lobar +wedge resection as the main approach.In the lymph node sampling group,patients with a maximum tumor length<2cm and Lobar+wedge shaped,segmental+wedge shaped resection as the main approach(p<0.05).There was no significant difference in postoperative complications between the patients in the selective lymph node dissection group and the lymph node sampling group,and there was no statistically significant difference in postoperative hospital stay,surgical duration,intraoperative bleeding,total postoperative chest drainage,and chest tube retention time(p>0.05).The 3-year OS of the patients in the selective lymph node dissection group was 88.3%,while the 3-year OS of the patients in the lymph node sampling group was 92.2%.Both groups had higher 3-year OS,There was no statistically significant difference in OS between the two groups of patients(p>0.05).The COX proportional risk model multivariate analysis showed that lymph node metastasis was an independent risk factor affecting the prognosis of patients in the selective lymph node dissection group(p<0.05),and the maximum tumor diameter>2cm was an independent risk factor affecting the prognosis of patients in the lymph node sampling group(p<0.05).Conclusion:Approximately 88.6% of s MPLC patients undergoing surgical resection did not detect lymph node metastasis.The level of carcinoembryonic antigen CEA ≥ 5ng/ml is a factor affecting s MPLC lymph node metastasis.The postoperative clinical parameters in the selective lymph node dissection group were not superior to those in the lymph node sampling group.There was no statistically significant difference in 3-year OS between the selective lymph node dissection group and the lymph node sampling group.Lymph node metastasis is an independent risk factor for poor prognosis in patients in the selective lymph node dissection group,with a maximum tumor length greater than 2cm being an independent risk factor affecting the prognosis of patients in the lymph node sampling group,patients with a tumor length diameter ≥ 2cm should receive early intervention.Selective lymph node dissection should be considered for s MPLC patients with CEA level ≥ 5ng/ml,preoperative maximum short diameter of hilar mediastinal lymph nodes ≥ 1cm,maximum tumor length diameter>2cm,different tumor histological types,sum of tumor length and diameter>3cm,and solid tumor imaging characteristics... |
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