Analysis Of Influence Factors On Lymph Node Skip-metastasis In Stage PN2Non-small Cell Lung Cancer

ObjectiveCurrently clinical research of lymph node skip-metastasis is more for non-smallcell lung cancer,but which factors prone to skip-metastasis are still controversial. Inthis study,we analyzed clinicopathologic features of NSCLC patients with mediastinallymph node (N2) skip metastasis,and provided reference for clinical practice.MethodsA total of281N2NSCLC cases were Included in the study.These Patients weresurgically treated in The Union Hospital of Fujian Medical University betweenJanuary2001and2012January.256cases met the inclusion criteria were divided intoskip metastasis group (N2skip+) and non-skip metastasis group (N2skip-). Theirmedical records were reviewed and the clinicopathologic characteristics wereretrospectively analyzed.Measurement data were converted into ranked data,enumeration data were analyzed using chi-square and ranked data were analyzedusing Wilcoxon rank sun test for single factor analysis.Finally each possibleinfluencing factors were analyzed using a logistic regression model.All the analysiswere conducted suing SPSS18.0.All tests were taken of two-sided test,P values lessthan0.05was considered statistically significant.ResultsA total of256patients with Primary non-small cell lung cancer were includedin the final analysis;among which184cases were male (71.9%),72cases were women(28.1%).Of those,65(26.0%) whose primary tumor were in right upper lobes,10(4.0%)in right middle lobes,52(20.8%) in right lower lobes,74(29.6%) in left upper lobes,49(19.6%) in left lower lobes and6(2.3%) in the hilus pulmonis.Base on pathologicalexaminations,there were141cases of adenocarcinoma (55.1%),90squamous cellcarcinoma (35.2%),25the others (9.7%).256patients underwent radical surgicalresection plus mediastinal nodal dissection,143underwent Conventional Surgery (55.9%),22underwent VATS Thoracic Small Incision (8.6%) and91underwentThoracoscopic operation (35.5%).There were73patients tumors with visceral pleuralinvolvement (28.5%),183without visceral pleural involvement (71.5%).135cases hadsmoking history (52.7%),121cases did not (47.3%);22cases differentiated well(8.6%),182cases differentiated moderate (71.1%),52cases differentiated poor(20.3%).The mean age was (58.5士9.6)years.The mean tumor size was (47.5士21.7)mm.The distribution of the four categories:69patients (27.0%) in groupA(≤30mm),116patients (45.3%) in group B(30to50mm),41patients (16.0%) in groupC (50to70mm) and30patients (11.7%) in group D(>70mm).Three was no statisticalsignificance between patients with skip and non-skip N2metastasis ingender,histology,differentiation,operation mode,pleural invasion,smoking,age,tumorlocation (P>0.05) except for the tumor size(P <0.05).ConclusionThis study showed that the size of the tumor is an independent influence factor oflymph node skip-metastasis in stage pN2non-small cell lung cancer,but visceralpleural involvement is not.