The Regularity And Clinical Analysis Of Intrapulmonary Lymph Node Metastasis In Non-small Cell Lung Cancer

Objective: To explore the regularity and clinical pathological characteristics of intra-pulmonary lymph node(LN)metastasis in non-small cell lung cancer(NSCLC).Methods: We performed clinical and pathological analysis of 60 patients with NSCLC underwent pneumonectomy or lobectomy and lymphadenectomy.Results:(1)A total of 615 intrapulmonary LNs were resected.Positive frequency of intrapulmonary LNs was 12.4%.The positive rates of LN stations No.10,No.11,No12.No13+14 were 10.2%,10.1%,17.6%,8.9%,respectively.A total of 328 LNs in group 12-14 were resected,and the number of positive LNs was 47,and metastasis rate was 14.3%.Among 24 patients with nodal involvement in group 12-14,four patients were identified without mediastinal and other intrapulmonary LN metastases.The detection rate was 6.7%.And three of them are peripheral NSCLC.(2)The significant difference was noted among the metastatic rates of LN stations No.12-No.14 in patients with T1~T3 staging(P<0.05);The metastatic rates of LN stations No.12-No.14 in patients with squamous cell carcinoma was higher than that in patients with adenocarcinoma,and the difference was statistically significant(P<0.05);The metastatic rates of LN stations No.12-No.14 was no significantly difference in patients with peripheral lung cancer than that in patients with central lung cancer(P>0.05).(3)A total of 95 non-primary tumor-bearing lobe or segment bronchial(NTBL/NTBS)LNs were cleared in 60 patients with NSCLC.There were 7 patients with NTBL/NTBS lymph nodes metastases,with transfer rate of 11.7%(7/60)in all cases.Respectively,the right lower lobe of the lung cancer with right middle lobe bronchial LN metastasis in 2 cases,and left lower lobe carcinoma with left upper lobe and segmental bronchial LN metastasis in 4 cases(including the left lobe of the upper lobe of bronchial LN metastasis in 2 cases),and left lobular carcinoma with esophageal LN metastasis in 1 case.There were 13 NTBL/NTBS lymph nodes with metastases,the positive rate of LNs was 13.7%(13/95).Respectively,there are 6 right middle lobe bronchial LNs,and 7 left upper lobe bronchial LNs,of which there are two upper lobe of the upper lobe of the bronchial LNs.Imaging features show that all cases are all solid tumors.Pathological type showed 4 cases of invasive adenocarcinoma,2 case of poorly differentiated squamous cell carcinoma,and 1 case of large cell carcinoma.Pathological staging showed two cases of ?A period(both T1,of which 1 case only occurred NTBL/NTBS lymph node metastasis),and 5 cases of stage ?A(of which 2 case only occurred NTBL/NTBS lymph node metastasis).Tumor location showed 3 cases of central lung cancer,4 cases of peripheral lung cancer.Conclusion:(1)Intrapulmonary LN metastasis rate occupies a considerable proportion in NSCLC,and the law of LN metastasis is consistent with that of intrathoracic LN metastasis.We should pay attention to the dissection of intrapulmonary LNs in early NSCLC patients.Particular attention should be paid to the detection of LNs in group 12-14.It is of great significance for the accurate acquisition of N1 staging in early NSCLC patients.(2)For patients with peripheral adenocarcinoma,particular attention should be paid to the dissection of NTBL lymph nodes.Especially for the primary tumor in the bilateral lower lobe and associated with extraocular LN metastasis(N2)in patients with NSCLC,we should pay attention to the middle right lobe bronchial LNs and left upper lobe and bronchial LNs dissection.Clinically for early NSCLC patients with solid nodular tumors,in the line wedge resection or anatomic lung resection,it should be considered the possibility of NTBS lymph nodes metastasis.Especially for the primary tumor in the left lung of patients with NSCLC,to prevent the possibility of missing LNs,special attention should be paid to the dissection of left upper lobe bronchial LNs and tongue segment bronchial LNs.For pure GGO lesions without extraocular LNs metastasis,there rarely occurs NTBL/NTBS lymph nodes metastasis,so the resection is of little significance.