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目的观察直径小于2 cm实性非小细胞肺癌(NSCLC)的淋巴结转移情况,并分析淋巴结转移的危险因素。方法回顾性分析2005年10月至2016年9月间在我院行肺叶切除术及系统淋巴结清扫的611例直径小于2 cm的实性NSCLC患者的临床资料,其中男322例、女289例,平均年龄25~84(58.8±10.0)岁。并以logistic回归模型分析淋巴结转移的危险因素。结果 611例患者中,发生淋巴结转移136例(22.3%),未发生淋巴结转移475例(77.7%)。单因素分析结果显示,性别(P=0.032)、分化程度(P<0.001)和病变位置(P=0.047)均与淋巴结转移有关。多因素分析结果显示,分化程度是影响直径小于2 cm实性NSCLC淋巴结转移的独立因素(P<0.001)。结论直径小于2 cm的实性NSCLC,仍有较高的淋巴结转移率,且病理分化程度低是其发生淋巴结转移的独立危险因素。对于直径小于2 cm的实性NSCLC仍应行系统性淋巴结清扫,并慎行亚肺叶切除。
Objective To observe the lymph node metastasis of solid non-small cell lung cancer (NSCLC) less than 2 cm in diameter, and to analyze the risk factors of lymph node metastasis. Methods The clinical data of 611 patients with solid NSCLC less than 2 cm in diameter undergoing lobectomy and systemic lymph node dissection in our hospital from October 2005 to September 2016 were retrospectively analyzed. There were 322 males and 289 females, The average age ranged from 25 to 84 (58.8 ± 10.0) years. Logistic regression model was used to analyze the risk factors of lymph node metastasis. Results Of the 611 patients, 136 (22.3%) had lymph node metastases and 475 (77.7%) had no lymph node metastases. Univariate analysis showed that gender (P = 0.032), differentiation (P <0.001) and pathological location (P = 0.047) were all associated with lymph node metastasis. Multivariate analysis showed that the degree of differentiation was an independent factor affecting the lymph node metastasis of solid NSCLC less than 2 cm in diameter (P <0.001). Conclusion Solid NSCLC less than 2 cm in diameter still has a high rate of lymph node metastasis, and the low degree of pathological differentiation is an independent risk factor for lymph node metastasis. Systemic lymph node dissection should be performed on solid NSCLC less than 2 cm in diameter, and cautious sub-lobectomy.