Study On Lymph Node Metastasis Of Lung Adenocarcinoma And Establishment Of Prediction Model

OBJECTIVETo study the relationship between the possible influencing factors such as primary tumor site,diameter and pathological subtypes in lung adenocarcinoma and lymph node metastasis,evaluate the possible risk factors,in order to judge the characteristics and rules of lymph node metastasis,and establish a possible prediction model,so as to provide certain reference for guiding intraoperative lymph node dissection.METHODSCollect university affiliated hospital of Qingdao laoshan campus thoracic surgery in November 2018-04,2019,a total of 258 after surgical resection in patients with lung adenocarcinoma,statistics and into the patient’s basic information and tumor pathological special information,analyzing the characteristics of the lymph node metastasis stations,using chi-square test to compare the difference of lymph node metastasis,stations of possible risk factors for the single factor analysis and Logistic analysis.RESULTSA total of 258 patients were enrolled,including 88 males and 170 females,aged 59.3±9.2 years.A total of 1,449 groups of 3499 lymph nodes were dissected,with an average of 13.56 nodes in 5.62 groups per patient,of which 66 were positive and 130 lymph nodes had metastases,accounting for 4.6%(66/1449)of the total dissected group and 3.7%(130/3499)of the total number of lymph nodes.There were 89 cases of right upper lobe,16 cases of right middle lobe,55 cases of right lower lobe,56 cases of left upper lobe and 42 cases of left lower lobe.The highest rate of metastasis of all pulmonary lobes was 43.6%(24/55)in the lower lobe of the right lung.Among the primary pulmonary lobes of all tumors,the frequency of lymph node metastasis in the N1 region was significantly higher than that in other regions.However,there was no significant statistical difference between different pulmonary interlobular lymph node metastases.In the mediastinal lymphatic region,the subcarinal lymphatic region had the highest metastasis frequency of 8.6%(10/232).There were 52 cases of adherent type,128 cases of acinar type,13 cases of papillary type,1 case of micropapillary type,12 cases of solid type and 9 cases of mucous type.Univariate and multivariate analyses revealed that the larger the tumor diameter [P<0.05,OR=1.988,95%ci(1.355,2.916)],and the subtype of pathology was solid [P=0.02,OR=0.145,95%ci(0.028,0.742)] were independent risk factors for superior mediastinal lymph node metastasis.The tumor diameter of the risk factor for lymph node metastasis in the lower mediastinal region was larger [P=0.038,OR=2.021,95%ci(2.021,1.041)].The pathological subtype was solid(P=0.015),the maximum diameter of the tumor(P=0.013),the age was over 60 years old(P=0.024),and the primary location of the tumor in the lower lobe(P=0.025)was an independent risk factor for lymph node metastasis in the subcarinal region of lung adenocarcinoma.CONCLUSIONS1.The lymph node regions of different primary lung adenocarcinomas have different metastasis rules,and the metastasis rate of N1 and subcarinal lymph nodes in each lung lobe is high,which is an important site for lymph node dissection.2.Lymph node metastasis in patients with lung adenocarcinoma is closely related to tumor diameter(T stage).3.The known pathological subtypes of patients with lung adenocarcinoma can be used to predict the metastasis of lymph nodes in each region and to guide the dissection of surgical lymph nodes in the hope of improving the prognosis of patients.