中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2011年
6期
479-482
,共4页
李瑞健%赵路军%巩琳琳%王平
李瑞健%趙路軍%鞏琳琳%王平
리서건%조로군%공림림%왕평
癌,小细胞肺/放射疗法%肿瘤转移,淋巴结%放疗范围
癌,小細胞肺/放射療法%腫瘤轉移,淋巴結%放療範圍
암,소세포폐/방사요법%종류전이,림파결%방료범위
Carcinoma,small cell lung/radiotherapy%Neoplasms metastasis,lymph node%Radiotherapy range
目的 通过分析小细胞肺癌(small cell lung cancer,SCLC)胸内淋巴结转移方式和规律,探讨SCLC放疗靶区的合理范围.方法 对本院150例接受根治性切除及系统性淋巴结清扫的局限期SCLC患者的胸内淋巴结进行分组及病理检查,分析胸内各组淋巴结的转移方式和规律.结果 150例SCLC患者共清扫胸内631个组的2372个淋巴结,经病理证实188个组(29.8％)的413个淋巴结(17.4％)存在转移,88例(58.7％)患者存在胸内淋巴结转移.胸内淋巴结转移率较高的是11、10、7、5、4组,中央型、T分期晚的患者更易发生淋巴结转移(x2 =15.32、39.72,P=0.000、0.000).右肺上叶和中下叶肺癌淋巴结高危转移区域分别为4、7、10组和4、7、10、11组,左肺上叶和下叶肺癌淋巴结高危转移区域分别为4、5、6、10组和4、7、9、10、11组.纵隔淋巴结转移72例,其中无肺门淋巴结转移的跳跃性转移29例(肺上叶癌主要向上纵隔淋巴结,肺中下叶癌可向上、下纵隔淋巴结).结论 SCLC胸内淋巴结遵循由肺内经肺门向纵隔依次转移的规律,但存在部分跳跃性转移；对不同肺叶肺癌对应的高危淋巴结转移区域给予预防照射有可能提高SCLC的放疗增益比.
目的 通過分析小細胞肺癌(small cell lung cancer,SCLC)胸內淋巴結轉移方式和規律,探討SCLC放療靶區的閤理範圍.方法 對本院150例接受根治性切除及繫統性淋巴結清掃的跼限期SCLC患者的胸內淋巴結進行分組及病理檢查,分析胸內各組淋巴結的轉移方式和規律.結果 150例SCLC患者共清掃胸內631箇組的2372箇淋巴結,經病理證實188箇組(29.8％)的413箇淋巴結(17.4％)存在轉移,88例(58.7％)患者存在胸內淋巴結轉移.胸內淋巴結轉移率較高的是11、10、7、5、4組,中央型、T分期晚的患者更易髮生淋巴結轉移(x2 =15.32、39.72,P=0.000、0.000).右肺上葉和中下葉肺癌淋巴結高危轉移區域分彆為4、7、10組和4、7、10、11組,左肺上葉和下葉肺癌淋巴結高危轉移區域分彆為4、5、6、10組和4、7、9、10、11組.縱隔淋巴結轉移72例,其中無肺門淋巴結轉移的跳躍性轉移29例(肺上葉癌主要嚮上縱隔淋巴結,肺中下葉癌可嚮上、下縱隔淋巴結).結論 SCLC胸內淋巴結遵循由肺內經肺門嚮縱隔依次轉移的規律,但存在部分跳躍性轉移；對不同肺葉肺癌對應的高危淋巴結轉移區域給予預防照射有可能提高SCLC的放療增益比.
목적 통과분석소세포폐암(small cell lung cancer,SCLC)흉내림파결전이방식화규률,탐토SCLC방료파구적합리범위.방법 대본원150례접수근치성절제급계통성림파결청소적국한기SCLC환자적흉내림파결진행분조급병리검사,분석흉내각조림파결적전이방식화규률.결과 150례SCLC환자공청소흉내631개조적2372개림파결,경병리증실188개조(29.8％)적413개림파결(17.4％)존재전이,88례(58.7％)환자존재흉내림파결전이.흉내림파결전이솔교고적시11、10、7、5、4조,중앙형、T분기만적환자경역발생림파결전이(x2 =15.32、39.72,P=0.000、0.000).우폐상협화중하협폐암림파결고위전이구역분별위4、7、10조화4、7、10、11조,좌폐상협화하협폐암림파결고위전이구역분별위4、5、6、10조화4、7、9、10、11조.종격림파결전이72례,기중무폐문림파결전이적도약성전이29례(폐상협암주요향상종격림파결,폐중하협암가향상、하종격림파결).결론 SCLC흉내림파결준순유폐내경폐문향종격의차전이적규률,단존재부분도약성전이；대불동폐협폐암대응적고위림파결전이구역급여예방조사유가능제고SCLC적방료증익비.
Objective To explore the reasonable radiotherapy range by analyzing the patterns and characteristics of intra-thoracic lymph node metastasis in small cell lung cancer (SCLC).Methods One hundred and fifty patients with limited-stage SCLC who received radical resection of primary tumor and systemic intra-thoracic lymph node dissection were included in the study.All the lymph nodes in each area were recorded and examined pathologically to analyze the patterns and characteristics of intra-thoracic lymph node metastasis.Results A total of 2372 lymph nodes were found in 631 areas,and a total of 413 positive lymph nodes (17.4％) were found in 188 lymph node areas (29.8％ ).Intra-thoracic lymph node metastasis were found in 88 patients,with a positive rate of 58.7％.The frequencies of metastasis in the area 11,10,7,5,4 were much higher than those in the other areas,and central located lesions and the higher T-stage lung tumors were more likely to develop intra-thoracic lymph node metastasis (x2 =15.32,39.72;P =0.000,0.000,respectively).Tumors located in the right upper lobe and right middle/lower lobe had a higher tendency of metastasis to the areas 4,7,10 and 4,7,10,11,respectively.Tumors located in the left upper lobe and left lower lobe had a higher tendency of metastasis to the areas 4,5,6,10 and 4,7,9,10,11,respectively.Mediastinal lymph node metastasis (N2 ) were found in 72 patients,among whom 29 patients (40.3％ ) had skipping N2 metastasis without hilar metastasis.Tumors located in the upper lobe had a tendency of skipping metastasis to the upper mediastinum,while tumors located in the middle/lower lobe had a tendency of skipping metastasis to the upper and lower mediastinum.Conclusions The lymph node metastases in SCLC follow the lymphatic drainage routes,that is,from intrapulmonary to the hilar and then to the mediastinum,but with some skipping metastases.Tumors located in different lobes have different high risk lymph node areas for metastasis,and elective irradiation to these lymph node areas maybe increase radiotherapy gain ratio in SCLC.
