张家齐;刘磊;王桂阁;白文梁;李单青;
ZHANG Jia-qi;LIU Lei;WANG Gui-ge;BAI Wen-liang;LI Shan-qing;Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院胸外科

摘要(Abstract)：

肺癌作为全球肿瘤致死的首要原因,发病率逐年上升。其主要治疗方式,尤其对于早期非小细胞肺癌患者,手术治疗依然占主导地位,而淋巴结转移状态对于肺癌的分期、预后至关重要。跳跃性N2淋巴结转移比较常见,且与患者预后密切相关。本文主要归纳非小细胞肺癌跳跃性N2淋巴结转移的临床病理特点及其预后,以期为临床决策提供一定指导。
Non-small cell lung cancer( NSCLC) is the leading cause of cancer-related death in the world. The main treatment is surgery intervention,especially for the early-stage of NSCLC. The pathological lymph node metastasis is closely associated with the staging and prognosis of patients. Among N2 metastasis,skip N2 metastasis is a quite common phenomenon with a better prognosis. The aim of this article is to summarize the clinical pathological features and prognosis of NSCLC with skip N2 metastasis and to guide the clinical decision making.

关键词(KeyWords)： 非小细胞肺癌;跳跃性N2转移;临床病理特点;预后
non-small cell lung cancer;skip N2 metastasis;clinical pathological features;prognosis

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张家齐;刘磊;王桂阁;白文梁;李单青;
ZHANG Jia-qi;LIU Lei;WANG Gui-ge;BAI Wen-liang;LI Shan-qing;Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

Email:

DOI:

参考文献(References)：

• [1]Detterbeck FC,Nicholson AG,Franklin WA,et al.The IASLC Lung Cancer Staging Project:Summary of Proposals for Revisions of the Classification of Lung Cancers with Multiple Pulmonary Sites of Involvement in the Forthcoming Eighth Edition of the TNM Classification[J].J Thorac Oncol,2016,11:639-650.
• [2]Detterbeck FC,Marom EM,Arenberg DA,et al.The IASLC Lung Cancer Staging Project:Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification[J].JThorac Oncol,2016,11:666-680.
• [3]Detterbeck FC,Chansky K,Groome P,et al.The IASLCLung Cancer Staging Project:Methodology and Validation Used in the Development of Proposals for Revision of the Stage Classification of NSCLC in the Forthcoming(Eighth)Edition of the TNM Classification of Lung Cancer[J].JThorac Oncol,2016,11:1433-1446.
• [4]Detterbeck FC,Boffa DJ,Kim AW,et al.The Eighth Edition Lung Cancer Stage Classification[J].Chest,2017,151:193-203.
• [5]Kirsh MM,Kahn DR,Gago O,et al.Treatment of bronchogenic carcinoma with mediastinal metastases[J].Ann Thorac Surg,1971,12:11.
• [6]Libshitz HI,McKenna RJ,Mountain CF.Patterns of mediastinal metastases in bronchogenic carcinoma[J].Chest,1986,90:229-232.
• [7]Isaka M,Kojima H,Takahashi S,et al.Risk factors for local recurrence after lobectomy and lymph node dissection in patients with non-small cell lung cancer:Implications for adjuvant therapy[J].Lung Cancer,2018,115:28-33.
• [8]Riquet M,Assouad J,Bagan P,et al.Skip mediastinal lymph node metastasis and lung cancer:a particular N2 subgroup with a better prognosis[J].Ann Thorac Surg,2005,79:225-233.
• [9]Benoit L,Anusca A,Ortega-Deballon P,et al.Analysis of risk factors for skip lymphatic metastasis and their prognostic value in operated N2 non-small-cell lung carcinoma[J].Eur J Surg Oncol,2006,32:583-587.
• [10]Misthos P,Sepsas E,Athanassiadi K,et al.Skip metastases:analysis of their clinical significance and prognosis in the IIIA stage of non-small cell lung cancer[J].Eur J Cardiothorac Surg,2004,25:502-508.
• [11]孟迪.N2淋巴结跳跃性转移在肺癌中的临床特点和预后分析[D].杭州:浙江大学,2016.
• [12]Guerrera F,Renaud S,TabbóF,et al.Epidermal growth factor receptor mutations are linked to skip N2 lymph node metastasis in resected non-small-cell lung cancer adenocarcino-mas[J].Eur J Cardiothorac Surg,2017,51:680-688.
• [13]Li H,Hu H,Wang R,et al.Lung adenocarcinoma:Are skip N2 metastases different from non-skip?[J].J Thorac Cardiovasc Surg,2015,150:790-795.
• [14]Li GL,Zhu Y,Zheng W,et al.Analysis of factors influencing skip lymphatic metastasis in p N(2)non-small cell lung cancer[J].Chin J Cancer Res,2012,24:340-345.
• [15]Sonobe M,Date H,Wada H,et al.Prognostic factors after complete resection of p N2 non-small cell lung cancer[J].JThorac Cardiovasc Surg,2013,146:788-795.
• [16]Takahashi K,Sasaki T,Nabaa B,et al.Pulmonary lymphatic drainage to the mediastinum based on computed tomographic observations of the primary complex of pulmonary histoplasmosis[J].Acta Radiol,2012,53:161-167.
• [17]Misthos P,Sepsas E,Kokotsakis J,et al.The significance of one-station N2 disease in the prognosis of patients with nonsmall-cell lung cancer[J].Ann Thorac Surg,2008,86:1626-1630.
• [18]Shigemoto Y,Suga K,Matsunaga N.F-18-FDG-avid lymph node metastasis along preferential lymphatic drainage pathways from the tumor-bearing lung lobe on F-18-FDG PET/CT in patients with non-small-cell lung cancer[J].Ann Nucl Med,2016,30:287-297.
• [19]Ito M,Yamashita Y,Miyata Y,et al.Prognostic impact of the primary tumor location based on the hilar structures in non-small cell lung cancer with mediastinal lymph node metastasis[J].Lung Cancer,2012,76:93-97.
• [20]Kawano R,Hata E,Ikeda S,et al.Lobe-specific skip nodal metastasis in non-small cell lung cancer patients[J].Ann Thorac Cardiovasc Surg,2008,14:9-14.
• [21]Ilic N,Petricevic A,Arar D,et al.Skip mediastinal nodal metastases in the IIIa/N2 non-small cell lung cancer[J].JThorac Oncol,2007:1018-1021.
• [22]Tanaka F,Takenaka K,Oyanagi H,et al.Skip mediastinal nodal metastases in non-small cell lung cancer[J].Eur JCardiothorac Surg,2004,25:1114-1120.
• [23]Casali C,Stefani A,Natali P,et al.Prognostic factors in surgically resected N2 non-small cell lung cancer:the importance of patterns of mediastinal lymph nodes metastases[J].Eur J Cardiothorac Surg,2005,28:33-38.
• [24]王思愚,吴一龙,区伟,等.非小细胞肺癌纵隔淋巴结跳跃性转移的研究[J].中华肿瘤杂志,2001,23:259-261.
• [25]Gorai A,Sakao Y,Kuroda H,et al.The clinicopathological features associated with skip N2 metastases in patients with clinical stage IA non-small-cell lung cancer[J].Eur J Cardiothorac Surg,2015,47:653-658.
• [26]Pezzella F,Turley H,Kuzu I,et al.Bcl-2 protein in nonsmall-cell lung carcinoma[J].N Engl J Med,1993,329:690-694.
• [27]Ohsaki Y,Toyoshima E,Fujiuchi S,et al.bcl-2 and p53protein expression in non-small cell lung cancers:correlation with survival time[J].Clin Cancer Res,1996,2:915-920.
• [28]Prenzel KL,Baldus SE,M9nig SP,et al.Skip metastasis in nonsmall cell lung carcinoma[J].Cancer,2004,100:1909-1917.
• [29]Komatsu H,Mizuguchi S,Izumi N,et al.Sialyl Lewis X as a predictor of skip N2 metastasis in clinical stage IA nonsmall cell lung cancer[J].World J Surg Oncol,2013,11:309.
• [30]Takizawa H,Sakiyama S,Tsuboi M,et al.Demonstration of the skip metastasis pathway for N2 non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2014,147:20022-25223.
• [31]Imai K,Minamiya Y,Saito H,et al.Detection of pleural lymph flow using indocyanine green fluorescence imaging in non-small cell lung cancer surgery:a preliminary study[J].Surg Today,2013,43:249-254.
• [32]Ohta Y,Shimizu Y,Minato H,et al.Results of initial operations in non-small lung cancer patients with single-level N2disease[J].Ann Thorac Surg,2006,81:427-433.
• [33]Goldstraw P,Crowley J,Chansky K,et al.The IASLC Lung Cancer Staging Project:Proposals for the Revision of the TNM Stage Groupings in the Forthcoming(Seventh)Edition of the TNM Classification of Malignant Tumours[J].JThorac Oncol,2007,2:706-714.
• [34]Yazgan S,Ucvet A,Gursoy S,et al.Single-station skip-N2disease:good prognosis in resected non-small-cell lung cancer(long-term results in skip-N2 disease)[J].Interact Cardiovasc Thorac Surg,2019,28:247-252.
• [35]Akcay O.Skip metastasis in non-small cell lung cancer:does it affect the prognosis?[J].Turk J Thorac Cardiovasc Surg,2017,25:230-234.
• [36]Gawrychowski J,Gabriel A,Lackowska B.Heterogeneity of stage IIIA non-small cell lung cancers(NSCLC)and evaluation of late results of surgical treatment[J].Eur J Surg Oncol,2003,29:178-184.
• [37]Fukuse T,Hirata T,Naiki H,et al.Prognostic significance of proliferative activity in p N2 non-small-cell lung carcinomas and their mediastinal lymph node metastases[J].Ann Surg,2000,232:112-118.
• [38]Oyaizu T,Sagawa M,Sato M,et al.The pattern of mediastinal nodal involvement in lung cancer according to tumor-located lobe[J].Kyobu Geka,1999,52:890-894.
• [39]Yoshino I,Yokoyama H,Yano T,et al.Skip metastasis to the mediastinal lymph nodes in non-small cell lung cancer[J].Ann Thorac Surg,1996,62:1021-1025.
• [40]Citak N,Sayar A,Metin M,et al.The prognostic signi-ficance of metastasis to lymph nodes in aortopulmonary zone(stations 5 and 6)in completely resected left upper lobe tumors[J].Thorac Cardiovasc Surg,2015,63:568-576.
• [41]Cheng X,Zheng D,Li Y,et al.Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage I non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2018,155:2648-2656.
• [42]张翀.临床Ia期非小细胞肺癌纵隔N2淋巴结跳跃性转移的临床、影像和病理相关因素分析[D].杭州:浙江大学,2017.
• [43]李汉忠,张玉石,郑国洋.肿瘤免疫治疗:回顾与展望[J].协和医学杂志,2018,9:289-294.
• [44]Cavallin F,Alfieri R,Scarpa M,et al.Nodal skip metastasis in thoracic esophageal squamous cell carcinoma:a cohort study[J].BMC Surg,2017,17:49.
• [45]Choi YY,An JY,Guner A,et al.Skip lymph node metastasis in gastric cancer:is it skipping or skipped?[J].Gastric Cancer,2016,19:206-215.