不同淋巴结清扫方式对cIA期肺腺癌患者围手术期的影响分析

Analysis of the Influence of Different Lymph Node Dissection Methods on the Perioperative Period of cIA Stage Lung Adenocarcinoma Patients

摘要: 目的：研究系统性纵隔淋巴结切除术(systematic mediastinal lymph node dissection, SMLD)、淋巴结采样(lymph node sampling, LNS)和叶特异性淋巴结清扫术(lobe-specific lymph node dissection, L-SND)对胸腔镜肺癌切除术患者的影响，进而探索临床IA期(Clinical Stage IA, cIA)肺腺癌患者最佳淋巴结清扫方式。方法：采用回顾性队列研究，利用“医渡云”系统收集603例2015年6月~2019年6月在青岛大学附属医院胸外科行胸腔镜手术的cIA期肺腺癌患者的临床资料。采用IBM SPSS 23.0软件完成统计学分析，计量资料的比较采用单因素方差分析或Kruskal-Wallis H检验；计数资料的比较采用χ2检验或Fisher’s确切概率法。单因素logistic回归分析pN的危险因素，并将有统计学意义的因素纳入多因素logistic回归分析。结果：肿瘤的大小、CTR、组织学类型、pN、术后并发症、置管时间以及住院时间在SMLD、LNS和L-SND三组间具有统计学差异，且多因素Logistic回归分析显示吸烟史(OR = 2.989，95%CI = 1.436~6.219，P = 0.03)、CTR (OR = 0.043，95%CI = 0.004~0.426，P = 0.007)是pN的独立危险因素。结论：CTR = 0或术中快速冰冻病理示AIS的T1a-3aN0M0患者可不进行淋巴结清扫；0 < CTR ≤ 0.5或术中快速冰冻病理示MIA的T1a-3aN0M0或0.5 < CTR < 1的T1aN0M0患者推荐LNS或L-SND；而0.5 < CTR ≤ 1的T2a-3aN0M0或CTR = 1的T1a-3aN0M0或术中快速冰冻病理示IDA尤其是PPA、MPA的患者则推荐SMLD。

Abstract: Objective: To study the effects of systematic mediastinal lymph node dissection (SMLD), lymph node sampling (LNS) and lobe-specific lymph node dissection (L-SND) on patients underwent vid-eo-assisted thoracoscopic surgery, and then explore an optimal lymph node dissection for patients with clinical stage IA (cIA) lung adenocarcinoma. Methods: In this retrospective cohort study, from June 2015 to June 2019, the clinical date of 603 patients with cIA lung adenocarcinoma who underwent video-assisted thoracoscopic surgery in the department of Thoracic Surgery of The Affiliated Hospital of Qingdao University were collected by using the “Medical Du Yun” system. IBM SPSS 23.0 statistical software was used to complete the statistical analysis, the measurement data were compared by one-way ANOVA or Kruskal-Wallis H test, and the counting data were compared by chisquare test or Fisher exact probability test. Univariate analysis was performed on the risk factors of pN, then the factors with statistically significant were included in multivariate logistic regression analysis. Results: There were statistically significant differences in tumor size, CTR, histo-logical type, pN, postoperative complications, time of intubation and time of hospital stay among SMLD, LNS and L-SND groups. Multivariate logistic regression analysis showed that smoking (OR = 2.989, 95%CI = 1.436~6.219, P = 0.03) and CTR (OR = 0.043, 95%CI = 0.004~0.426, P = 0.007) were independent risk factors of pN. Coclusions: For T1a-3aN0M0 patients with CTR = 0 or AIS, lymph node dissection may not be performed; LNS or L-SND is recommended when T1a- 3aN0M0 patients with 0 < CTR ≤ 0.5 or MIA and T1aN0M0 patients with 0.5 < CTR < 1; however, SMLD is recom-mended for T2a-3aN0M0 with 0.5 < CTR ≤ 1 or T1a-3aN0M0 with CTR = 1, or patients with IDA, especially PPA and MPA, as shown by intraoperative rapid freezing pathology.