Risk Assessment Of Prognosis And Lymph Node Metastasis Of Peripheral Small-sized, Non-small Cell Lung Cancer And Exploration Of Limited Resection

Objective:In recent years, with the increasing popularity of physical examination and the extensive application of new diagnostic echniques, such as high-resolution CT, chest low-dose spiral CT, the body positron emission tomography, the discovery of peripheral,small-sized, non-small cell lung cancer of 2 cm or less in diamete has increased significantly than before. Early detection of peripheral,small-sized, non-small cell lung cancer of 2 cm or less in diamet significantly increase the chance of surgical treatment of lung cancer surgery, improving the survival rate of patients with lung cancer.Therefore, surgical treatment strategy of peripheral small-sized non-small cell lung cancerr is especially important in the surgical treatment of lung cancer. The debate about limited resection (wedge resection or segmental resection) or standard lobectomy plus systematic hilar and mediastinal lymph node dissection for peripheral, small-sized, non-small cell lung cancer of 2 cm or less in diamete is becoming more fiercer. Through risk assessment of prognosis and lymph node metastasis of peripheral small-sized, non-small cell lung cancer of 2 cm or less in diamete, I want to further explore the pointer of the limited resection of peripheral,small-sized, non-small cell lung cancerMethods:A retrospective analysis of 99 patients from 2000.1 through 2007.12 who underwent a surgical resection for a peripheral non-small cell lung cancer of 2 cm or less in diameter was performed.74 patients were followed up for 3-115 months, lost 25 patients, survival analysis on the follow-up data is performed with the method of Kaplan-Meiyer single factor analysis and multivariate Cox regression analysis. Because survival analysis showed that gender (female is better than male in prognosis), lymph node metastasis, and CEA rise are the independent poor prognostic factors, lymph node metastasis and CEA rise were respectively elevated in the use of chi-square test and logistic multivariate analysis to determine their affective factors, consequently to identify clinical pathological factors of poor prognosis in peripheral,small-sized, non-small cell lung cancer.Results:Adenocarcinoma accounted for the majority (81.8%) of all patients and early lung cancer accounted for the majority of patients, pTNMⅠof 77.8%, but still 12% of patients with pTNMⅢ. The 1,3,5-year survival rate of the group of 74 patients followed successfully up were respectively 94%,76%,65%. Survival analysis showed that gender (female is better than male in prognosis), lymph node metastasis, and CEA rise were the independent poor prognostic factors of peripheral,small-sized, non-small cell lung cancer of 2 cm or less in diameter. Univariate analysis also showed 5-year survival rates for pTNM stage were respectively stageⅠ74.8%, stageⅡ38.6%, stageⅢ%, p＜0.005. For tumor cell different tiation,5-year survival rate of poor differentiation group is 0%, it was 78% in well-differentiated group, p＜0.005. Univariate analysis also showed that adenocarcinoma is more likely than non-adenocarcinoma in lymph node metastases, rate of lymph node metastasis in adenocarcinoma was 24.7%, it was 0% in non-adenocarcinoma,p=0.042. Logistic multivariate analysis showed that CEA is the independent risk factor for lymph node metastasis. Univariate and multivariate analysis both revealed that pleural invasion and poor differentiation in lung tumor cell are independent associated factors of CEA.rise.Conclusion:1.The majority of small peripheral lung cancer is adenocarcinoma (81.8%), and most of them is early lung cancer (of 77.8%).2. Sex, increased CEA level and metastasis of lymph node in small peripheral lung cancer were independent prognostic factors.3. Patients with Adenocarcinoma, increased CEA level are more likely involved metastasis of lymph node, and increased CEA level is an independent factor of metastasis of the lymph node.4. In the case of peripheral, small-sized, non-small cell lung cancer of 2 cm or less in diamete, if there are sign of pleura invision, CEA rise or poorly differentiated lung cancer cells, especially in male patients with adenocarcinoma before operation, it may have lymph node metastasis, prognosis may be poor, so we should not select limited resection, but should perform the standard lobectomy plus hilar and mediastinal lymph node dissection.If the above three indicators were negative, in particular, one of the following conditions:age, squamous carcinoma, heart and lung failure, tumor showed pure ground glass (PGGO) or in mixed ground glass (MGGO) and the component of focus solid- turn is less than 50% of mixed ground glass (MGGO), or is mixed ground glass (MGGO) on HRCT and the component of focus solid- turn is not more than 5mm, the limitations resection is appropriate.