pN0期非小细胞肺癌伴淋巴结微转移的临床病理特征及其危险因素分析
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摘要
目的观察pN0期非小细胞肺癌(NSCLC)伴淋巴结微转移的病理特征,探讨其危险因素。方法纳入117例pN0期NSCLC患者,检测淋巴结微转移情况、血清同型半胱氨酸(Hcy)及胱抑素C(CysC)水平,调查患者临床病理特征,进行统计分析。结果淋巴结微转移检出率21.37%。血清Hcy、CysC水平对淋巴结微转移有一定诊断价值,ROC曲线下面积分别为0.741、0.933。T2+T3分期、非上叶肺癌、Hcy≥16.70μmol/L、CysC≥1.25 mg/L均是淋巴结微转移的独立危险因素(P<0.05)。发生淋巴结微转移患者累积生存时间明显短于未发生淋巴结转移患者(P<0.05)。结论 pN0期NSCLC患者易发生淋巴结微转移,发生淋巴结微转移者累积生存时间明显缩短。T2+T3分期、非上叶肺癌、Hcy≥16.70μmol/L、CysC≥1.25 mg/L均是淋巴结微转移的危险因素。
Objective To observe the clinicopathological features of pN0 stage non-small cell lung cancer(NSCLC)patients with lymph node micrometastasis,and to analyze its risk factors.Methods117 patients withstage pN0 NSCLC were collected. The lymph node micrometastasis,serum Hcy and CysC were detected,andclinicopathological features were observed.Results21.37% patients in observation group were with lymph nodemicrometastasis. The levels of Hcy and CysC had certain value in diagnosis of lymph node micrometastasis,andarea under ROC curve was 0.741 and 0.933 respectively. Stage T2 and T3,non-upper lobe lung cancer,Hcy ≥16.70 mol/L and CysC ≥ 1.25 mg/L were independent risk factors for lymph node micrometastasis(P < 0.05).The cumulative survival time of patients with lymph node micrometastasis was significantly shorter(P < 0.05).ConclusionLymph node micrometastases are common in patients with stage pN0 NSCLC,and patients withlymph node micrometastases have worse prognosis. Stage T2 and T3,non upper lobe lung cancer,Hcy ≥ 16.70mol/L and CysC ≥ 1.25 mg/L are independent risk factors for lymph node micrometastasis.
Objective To observe the clinicopathological features of pN0 stage non-small cell lung cancer(NSCLC)patients with lymph node micrometastasis,and to analyze its risk factors.Methods117 patients withstage pN0 NSCLC were collected. The lymph node micrometastasis,serum Hcy and CysC were detected,andclinicopathological features were observed.Results21.37% patients in observation group were with lymph nodemicrometastasis. The levels of Hcy and CysC had certain value in diagnosis of lymph node micrometastasis,andarea under ROC curve was 0.741 and 0.933 respectively. Stage T2 and T3,non-upper lobe lung cancer,Hcy ≥16.70 mol/L and CysC ≥ 1.25 mg/L were independent risk factors for lymph node micrometastasis(P < 0.05).The cumulative survival time of patients with lymph node micrometastasis was significantly shorter(P < 0.05).ConclusionLymph node micrometastases are common in patients with stage pN0 NSCLC,and patients withlymph node micrometastases have worse prognosis. Stage T2 and T3,non upper lobe lung cancer,Hcy ≥ 16.70mol/L and CysC ≥ 1.25 mg/L are independent risk factors for lymph node micrometastasis.
引文
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[2]JIN K,ZHANG K,ZHOU F,et al.Selection of candidates for surgery as local therapy among early-stage small cell lung cancer patients:a population-based analysis[J].Cancer Commun(Lond),2018,38(1):5.
[3]JEONG J H,KIM N Y,PYO J S.Prognostic roles of lymph node micrometastasis in non-small cell lung cancer[J].Pathol Res Pract,2018,214(2):240-244.
[4]LETO G,CRESCIMANNO M,FLANDINA C.On the role of cystatin C in cancer progression[J].Life Sci,2018,202:152-160.
[5]LIU Z,CUI C,WANG X,et al.Plasma Levels of Homocysteine and the Occurrence and Progression of Rectal Cancer[J].Med Sci Monit,2018,24:1776-1783.
[6]YANG L,WANG S,ZHOU Y,et al.Evaluation of the 7th and8th editions of the AJCC/UICC TNM staging systems for lung cancer in a large North American cohort[J].Oncotarget,2017,8(40):66784-66795.
[7]DENG X F,JIANG L,LIU Q X,et al.Lymph node micrometastases are associated with disease recurrence and poor survival for early-stage non-small cell lung cancer patients:a meta-analysis[J].J Cardiothorac Surg,2016,11:28.
[8]DAI C H,LI J,YU L C,et al.Molecular diagnosis and prognostic significance of lymph node micrometastasis in patients with histologically node-negative non-small cell lung cancer[J].Tumour Biol,2013,34(2):1245-1253.
[9]梁克诚,甘浪舸,阮林,等.细胞角蛋白表达与Ⅰ期非小细胞肺癌淋巴结微转移相关性研究[J].临床肺科杂志,2014,19(2):329-330.
[10]姜冠潮,李晓,张康,等.临床Ⅰ期非小细胞肺癌N1淋巴结转移的危险因素[J].中华胸心血管外科杂志,2015,31(3):161-163.
[11]SHIEN K,TOYOOKA S,SOH J,et al.Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division[J].Interact Cardiovasc Thorac Surg,2015,20(6):791-796.
[12]YANG F,DONG J,WANG X,et al.Non-small cell lung cancer:Spectral computed tomography quantitative parameters for preoperative diagnosis of metastatic lymph nodes[J].Eur J Radiol,2017,89:129-135.
[13]KASEDA K,ASAKURA K,KAZAMA A,et al.Risk factors for predicting occult lymph node metastasis in patients with clinical stage I non-small cell lung cancer staged by integrated fluorodeoxyglucose positron emission tomography/computed tomography[J].World J Surg,2016,40(12):2976-2983.
[14]LETO G,INCORVAIA L,FLANDINA C,et al.Clinical Impact of Cystatin C/Cathepsin L and Follistatin/Activin A Systems in Breast Cancer Progression:A Preliminary Report[J].Cancer Invest,2016,34(9):415-423.
[15]OHARA G,MIYAZAKI K,KURISHIMA K,et al.Serum levels of cystatin C in elderly lung cancer patients[J].Oncol Lett,2012,3(2):303-306.
[16]ZHANG J,HE P,ZHONG Q,et al.Increasing cystatin c and cathepsin b in serum of colorectal cancer patients[J].Clin Lab,2017,63(2):365-371.
[17]LAMB E J.Cystatin C:why clinical laboratories should be measuring it[J].Ann Clin Biochem,2015,52(Pt 6):709-711.
[18]OZKAN Y,YARDIM-AKAYDIN S,FIRAT H,et al.Usefulness of homocysteine as a cancer marker:total thiol compounds and folate levels in untreated lung cancer patients[J].Anticancer Res,2007,27(2):1185-1189.