Relationship Between Lymph Node Metastasis Of Lung Adenocarcinoma And Clinicopathological Features And Tumor Markers

ObjectiveThrough the analysis of the complete medical records of the patients with primary lung adenocarcinoma confirmed by pathology after operation in the First Affiliated Hospital of Zhengzhou University,who underwent EGFR gene detection and serum tumor markers detection before operation,this paper investigated the relationship between lymph node metastasis of primary lung adenocarcinoma and anthropological characteristics,tumor diameter,differentiation degree,EGFR mutation,primary tumor location,and expression levels of tumor markers CEA,CA125,CA19-9,CA72-4,CYFRA21-1 and TAP.Methods241 patients with primary lung adenocarcinoma who underwent surgery at the First Affiliated Hospital of Zhengzhou University from December 2015 to October 2019 were included.The differences of age,gender,smoking history,tumor diameter,differentiation degree,EGFR mutation,tumor primary location and tumor markers CEA,CA125,CA19-9,CA72-4,CYFRA21-1,TAP expression levels between the positive and negative group of lymph node metastasis were compared to clarify the relationship between lymph node metastasis of primary lung adenocarcinoma and clinicopathological characteristics(tumor diameter,degree of differentiation,EGFR mutation,tumor primary location)and tumor markers.ResultsUnivariate analysis showed that there were significant differences in age,tumor diameter,differentiation degree and expression level of CEA,CA125,CA19-9 and TAP in lymph node metastasis positive and negative groups(P<0.05);there were no significant differences in gender,smoking history,EGFR mutation,tumor location and expression level of CA72-4 and CYFRA21-1 in two groups(P>0.05).The potential influencing factors included in the multivariate analysis showed that the age less than 60,tumor diameter more than 1cm,poor differentiation degree and increased expression level of tumor markers CEA and CA125 were independent risk factors for lymph node metastasis of primary lung adenocarcinoma(P<0.05).There was no significant difference in the expression of tumor markers between the N1 and N2 lymph node metastasis groups(P>0.05).At the same time,there was no significant difference in EGFR mutation between the positive and negative lymph node metastasis groups,between the N1 and N2 lymph node metastasis groups,and between the jumping N2 metastasis group and the non jumping N2 metastasis group(P>0.05).According to the primary location of the tumor,the study data were divided into five groups:right upper lobe,left upper lobe,right lower lobe,left lower lobe,and right middle lobe.The lymph node metastasis rates were 24.7%(21/85),25.4%(15/59),27.7%(13/47),20.0%(7/35),26.7%(4/15),respectively.There was no significant difference between the groups(P>0.05).In addition,the study data were divided into upper lobe tumor group and middle lower lobe tumor group.Results showed that there was no significant difference in hilar lymph node metastasis,mediastinal lymph node metastasis,superior mediastinal,5,6 group lymph node metastasis and skipping N2 metastasis(P>0.05),but there was significant difference in inferior mediastinal lymph node metastasis between the two groups(P<0.05).ConclusionAges younger than 60,tumor diameter>1cm,poor differentiation,and elevated expression of tumor markers CEA and CA125 are independent risk factors for lymph node metastasis in primary lung adenocarcinoma.There were different mediastinal lymph node metastasis tendency in different primary location.The tumors in the upper lobe mainly metastasize to the superior mediastinum and the 5th and 6th groups of lymph nodes,while the metastasis in the inferior mediastinum is rare.The tumors in the middle and lower lobes often metastasize to the inferior mediastinum at the same time as the metastasis in the superior mediastinum and the 5th and 6th groups of lymph nodes.