Dissertation > Excellent graduate degree dissertation topics show

Clinical Study of Systemic Lymph Node Dissection in Primary Lung Cancer

Author: GaoZuo
Tutor: HanZhenGuo
School: Jilin University
Course: Clinical
Keywords: Lung cancer Lymph node mestastasis Systematic nodal dissection
CLC: R734.2
Type: Master's thesis
Year: 2009
Downloads: 63
Quote: 0
Read: Download Dissertation

Abstract

Objective To investigate the relationship between the size of primary tumor, pathologic classification, cell differentiation, or location of tumor and lymph node metastasis in lung cancer. and to study the frequency, distribution and feature of lymph nodes metastasis in lung cancer as to provide evidence for extensive dissection of lymph nodes and subsequent treatment post-operation .Method 168 primary lung cancer patients in China-Japan Union Hospital from Jau 2006 to Dec 2008 were studied retrospectively. All patients underwent surgery plus extensive dissection of hilar, inter lobor and mediastinal nodes according to the grouping system proposed by Naruke et al. The lymph node map proposed by Naruke et al indicated that N1/N2 including anatomic landmarks of stations 10-14 and stations 1-9, respectively. The regional mediastinal grouping system of Watanabe meaned that stations 1-6 belong to regional grouping map of upper lobal neoplasm(station 1-4, if it was right) and stations 7-9 belong to lower lobal cancer.Skip matastasis defined as there occured mediastinal nodal matastasis meanwhile no matastasis of N1 lymph node and skip mediastinal nodal metastasis meaned there were nodal mestastasis to the non-regional parts of the mediastinum without regional nodal involvement in the mediastinum. Lymph nodes and arounding fat tissue which were removed were classfied and fixed, finally embeded by paraffin, and then permanent microscope slides were formed and observed. all lymph nodes were histologically proven. All patients were staged by update lung cancer staging system by UICC in 1997. Follow-up data for all patients were analyzd. Possible factors associated the study were collected in the data of these patients. To study the size of primary tumor, pathologic classification, cell differentiation or location of tumor and lymph node metastasis in lung cancer, the distribution and feature of lymph nodes metastasis in lung cancer were also analyzed. All dates were analyzed using the statistics software of SPSS13.0. Pearson Chi-Square test was used to compare the various rates. Statistical significance was established at the P<0.05 level.Results 168 patients was studied. The nodal status was N0 in 74 patients, N1 in 32, N2 in 62 (36.9%), including N1+N2. And 94 patients had nodal metastasis (55.9%). Twenty patients were observed skip nodal metastasis, and skip metastatic nodes of N2 status could be fourd in 14 patients. Of 1572 lymph nodes, metastatic rates of N1 and N2 were27.8% and 21.8% respectively. The total lymph node metastatic rates of T1, T2, and T3 diseases were 9.8%、25.0% and 56.5% respectively (P<0.05). No lymphatic metastasis was observed in well differentiated squamous cell carcinoma, however, the lymph node metastatic rates in moderate and poor differentiated squamous cell carcinoma were 13.8% (44/320) and 21.5% (40/186) respectively (P<0.05), and the N2 metastatic rates were 7.4%(8/108)、15.6%(10/64)respectively(P>0.05). The lymph node metastatic rates were 23.9% (178/746) and 69.6% (78/112) in moderate and poor differentiated adenocarcinoma respectively (P<0.05), the N2 metastatic rates were 16.9%(46/272)、64.3%(36/56)respectively(P<0.05). Under the same T status, cell differentiation, the total metastatic rates and N2 metastatic rates of adenocarcinoma were much higher than those of squamous cell carcinoma (P<0.05). The total lymph node metastatic rates in central and peripheral lung cancer were 25.3% (182/720) and 22.9% (158/690) respectively(P>0.05). And the total lymph node metastatic rates in central and peripheral squamous cell carcinoma were 15.7% (56/356) and 14.3% (28/196) respectively(P>0.05), while in adenocarcinoma, the rates were 34.6% (126/364) and 26.3% (130/494) respectively (P<0.05). The N2 metastatic rates in central and peripheral squamous cell carcinoma were 14.6% (12/82) and 6.1% (6/98) respectively(P>0.05), while in adenocarcinoma, the rates were 27.5% (50/182) and 21.9% (32/146) respectively (P>0.05). There were 62 patients who occurred mediastinal nodal matastasis. Nodal metastases to the upper mediastinum from upper lobe lesions were frequently observed in stations 3、4、5. whereas those to the lower mediastinum from middle or lower lobe lesions were mainly found in station 7 .The regional nodal metastatic rates was 82% and 48% in upper lobe lesions and middle or lower lobe lesions, respectively. non-regional nodal metastatic rates was 18% and 53%. Respectively(P<0.05,upper lobe lesions vs middle or lower lobe lesions).Conclusion The frequency of lymph node metastasis significantly correlate with size of primary tumor, pathological classification and cell differentiation. The frequency of metastasis increases with the growth and invasion of tumor. The easier the lymph node spread, the lower the cell differentiate. Metastasis in adenocarcinoma occurs more frequently than in squamous carcinoma. Solitary and multiple metastasis are the characteristic of lymph nodes metastasis in lung cancer. Tumor at any site can metastasize to distant mediastinum. radical surgery can be achieved only by extensive dissection of intrapulmonary and ipsilateral mediastinal lymph nodes. Systematic mediastinal nodal dissection should be routinely performed for lung cancer which the neoplasm were completely removed to ensure the correct nodal status. Only so, the best therapy were performed, and which can provide basis for the following therapy.

Clinical Study of Systemic Lymph Node Dissection in Primary Lung Cancer

Abstract

Related Dissertations