| Background and purpose:At present,lung cancer is the most common cancer and the leading cause of cancer death worldwide.According to the World Health Organization,about 1.6million cases of lung cancer are diagnosed and about 1.4 million cases of lung cancer die every year in the United States.According to the prediction from national health agency of China,by 2025,the number of lung cancer patients in China is the largest in the world.At present,there has been great development in the fundamental research and treatment of lung cancer,new surgical methods and chemotherapeutic drugs have been put into clinical use.However,the survival rate and survival time are not significantly improved.The 5-year survival rate was only about 15%.According to the biological characteristics of lung cancer,it is mainly divided into small cell lung cancer(SCLC)and non-small-cell lung cancer(NSCLC).In China,NSCLC patients account for about 85% of all lung cancer patients.With the development of treatment methods,the comprehensive treatment of NSCLC mainly includes surgery,radiotherapy,chemotherapy,targeted therapy and biotherapy.Radiotherapy is an important treatment for early NSCLC and local advanced NSCLC patients who can not be operated or refused surgery.In the treatment of NSCLC,about 60-76% of patients need radiotherapy.Mediastinal lymph node metastasis is one of the important factors affecting the curative effect and prognosis of radiotherapy.At present,mediastinal lymph node involvement field radiation therapy(IFRT)is the main radiotherapy mode.Compared with selective lymph node irradiation(LNR),it can reduce the volume of target area and the absorbed dose of organs at risk(OARs),thereby reducing the incidence of radiation pneumonia.However,after treatment of IFRT,the recurrence rate of mediastinal lymph nodes is still about 8%.This indicates that the potential metastatic lymph nodes will be missed only based on the enhanced CT findings.According to the law of lymph node metastasis,we can reduce the recurrence rate and improve the local control rate of the tumor by selective preventiveirradiation on the basis of the involved field irradiation.However,there is no uniform understanding of the high-risk regions of lymph node metastasis in different cases all over the world.Therefore,the study of lymph node metastasis in patients with NSCLC can be used to improve the clinical effect.The clinical data of 120 patients with NSCLC from January 2013 to December 2017 in the department of radiotherapy,China-Japan Union Hospital of Jilin University were retrospectively analyzed,and the lymph node status of all patients was summarized.Statistical analysis of lymph node metastasis in each group of patients with different types of NSCLC was carried out,and the significance of delineating a reasonable range of target areas in NSCLC radiotherapy was preliminarily discussed in order to be helpful to clinical work.Materials and methods:Clinical data:From January 2013 to December 2017,we retrospectively analyzed the clinical data of NSCLC patients in the department of radiotherapy,China-Japan Union Hospital of Jilin University.The CT enhanced images of each patient before radiotherapy were reviewed,and then the lymph nodes metastasized on the image were collected.SPSS22.0 software,?2 test and Fisher accurate probability test were used to analyze the final data(P < 0.05).Results:1.The whole group of 120 patients,including 74 patients with lymph node metastasis,metastasis ratio of 61.7%.The lower lymph node metastasis frequency groups(less than 15%)were 1,2,3,6,8,9.And the lymph node metastasis rate were 12.5%?14.2%?11.7%?14.2%?5.8%?9.2%,respectively.The higher lymph node metastasis frequency groups(higher than 15%)were 4,5,7,10 and 11.And the lymph node metastasis rate were 39.2%?28.3%?45.8%?43.3%?42.5%,respectively..2.The results of univariate analysis of lymph node metastasis rate:2.1There were 86 cases of male,in which lymph node metastasis 53 cases,lymph node metastasis rate is 61.6%(53/86).There were 34 cases of female,in which lymph node metastasis 21 cases,lymph node metastasis rate is 61.7%(21/34).There was no significant difference in lymph node metastasis rate between two groups(P=0.078).2.2:There were 68 cases of age ? 60,in which 36 cases of lymph node metastasis,the proportion of lymph node metastasis is 52.9%(36/68).There were 52 cases of age over 60,in which 38 cases were lymph node metastasis,the proportion of lymph node metastasis was 73.1%(38/52).There was significant difference in lymph node metastasis rate between two groups(P =0.034).2.3:There were 46 cases of squamous cell carcinoma,in which 26 cases of lymph node metastasis,lymph node metastasis rate is 56.5%(26/46).There were 53 cases of adenocarcinoma,in which 40 cases of lymph node metastasis,lymph node metastasis rate is 75.5%(40/53).There was significant difference in lymph node metastasis between squamous cell carcinoma and adenocarcinoma(P = 0.025).2.4:There were 45 cases of central lung cancer,in which 36 cases of lymph node metastasis,lymph node metastasis rate is 80%(36 / 45).There were 75 cases of peripheral type patients,in which 38 cases of lymph node metastasis,lymph node metastasis rate is 50.1%(38 / 75)(P = 0.017).2.5:There were 38 cases of lung cancer ? 3.0 cm in diameter,20 cases of lymph node metastasis,lymph node metastasis is 52.6%(20/38).There were 46 cases of lung cancer between 3.1 cm to 5.0 cm in diameter,29 cases of lymph node metastasis,lymph node metastasis is 63.0%(29/46).There were 22 cases of lung cancer between5.1 cm to 7.0 cm in diameter,15 cases of lymph node metastasis,lymph node metastasis rate is 68.2%(15/22).There are 14 cases of lung cancer > 7.0cm in diameter,10 cases of lymph node metastasis,lymph node metastasis rate is 71.4%(10/14).As the diameter of the tumor increases,the lymph node metastasis rate increases.But there was no statistical difference(all P > 0.05).2.6:There were 16 cases of well-differentiated lung cancer,8 cases of lymph node metastasis,lymph node metastasis rate is 50.0%(8/16).There were 60 cases of moderately differentiated lung cancer,32 cases of lymph node metastasis,lymph node metastasis rate is 53.33%(32/60).There were 44 cases of poorly differentiated lung cancer,34 cases of lymph node metastasis,lymph node metastasis rate is 77.3%(34 /44).There was significant difference in lymph node metastasis between each two groups(all P < 0.05).2.7:There was significant difference in lymph node metastasis rate between left lobe and right lobe(P < 0.05).The rate of lymph node metastasis in right lobe was higher than that in left lobe,but there was no significant difference between upperlobe lung cancer and lower(middle)lobe lung cancer(P = 0.183).2.8:In 120 cases,the lymph node metastasis rates of T1?T2?T3?and T4 patients were 33.3%(4/12)?53.4%(31/58)?73.5%(25/34)?87.5%(14/16).There was significant difference in lymph node metastasis rate among patients with different T stages.The later the T stage was,the higher the lymph node metastasis rate was(P <0.05).2.9:There were 84 cases with smoking history,54 cases with lymph node metastasis,lymph node metastasis rate is 64.3%(54/84).There were 36 cases with no smoking history,20 cases with lymph node metastasis,lymph node metastasis rate is55.6%(20/32).There was no significant difference in lymph node metastasis rate between the two groups(P > 0.05).3:The highest three groups of lymph node metastasis rate for left upper lobe lung cancer were 10 L,4L and 7 group,which was 57.5%,38.5% and 26.7%respectively..The highest two groups of lymph node metastasis rate for left lower lobe lung cancer were 10 L and 4L,which was 54.2% and 29.2%,respectively.The highest three groups of lymph node metastasis rate for upper right lung cancer were 4R,7 and10 R group,which was 75.0%,57.1% and 57.1%,respectively.The highest three groups of lymph node metastasis rate for the right middle and lower lobe lung cancer were 4R ? 10 R and7 group,which was 54.8%,36.0% and 28.8%,respectively.Combined analysis of left and right lung showed that lung cancer of left lung was more likely to metastasize to 1L,4L,10 L,while lung cancer of right lung to 1R,2R,4R,7,10R(all P < 0.05).4:The incidence of jumping N2 is 10%(12/120).The probability of skip N2 metastasis in upper lobe cancer was 9.3 %(5/ 54)and 10.6%(7/66)in inferior(middle)lobar carcinoma.There was no significant difference between the two groups(P =0.251).Among all patients with skip metastasis,for upper lobe lung cancer,the skip N2 metastasis rate of upper mediastinum was 80%(4 / 5),the skip N2 metastasis rate of lower mediastinum was 20%(1/5),There is a significant difference between them(P=0.027);for lower and middle lung cancer,the skip N2 metastasis rate of upper mediastinum was 14.3%(1/7),and the skip N2 metastasis of lower mediastinum was 85%(6/7).There were significant differences between the two groups in both upper lobe lung cancer and lower and middle lung cancer(P = 0.035).Conclusion:1:In radiotherapy of non-small cell lung cancer,more attention should be paid to the lymph nodes in group 4,5,7,10,which have higher metastatic frequency.2: There was no significant correlation between regional lymph node metastasis rate and gender tumor diameter.It may be related to the degree of gross typing differentiation of pathological types in age T staging.3: There was no significant difference in the rate of lymph node metastasis in mediastinum between the left and right lung lobes.The higher lymph node metastasis rate in the left lung area was 10 L and 4L respectively.The higher lymph node metastasis rate in the right lung area was in the order of 4R,10 R,7 and 1R.4:The upper lobe lung cancer is prone to jump upward mediastinal metastasis,and lower(middle)lobe lung cancer is prone to lower mediastinal metastasis jump. |
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