手术切除直径≤2 cm非小细胞肺癌的术后临床病理研究

目的:探讨手术切除直径≤2cm非小细胞肺癌(non-small cell lung cancer，NSCLC)的临床病理特点。方法:选取2010年至2014年间治疗组共138例直径≤2 cm非小细胞肺癌的手术病例。通过临床病理资料及术后随访回顾性分析手术方式、淋巴结转移程度、组织病理类型等对术后生存的影响。结果:样本总体的5年生存率为71.7%。其中138例患者中共有24例（17.4%）发生淋巴结转移，无淋巴结转移的患者5年生存率为82.7%，而pN1和pN2患者的5年生存率分别为75.0%和48.1%，差异具有统计学意义（P<0.05）。接受肺叶切除术的患者5年生存率明显高于接受肺段或肺部分切除的患者（P<0.05）。患者术后肿瘤分期Ⅰ期、Ⅱ期、Ⅲ期的5年生存率分别为89.8%、77.8%和43.1%（P<0.05）。结论:直径≤2 cm的非小细胞肺癌患者的术后生存与手术方式、淋巴结转移程度及肿瘤分期密切相关，肿瘤的大小不应作为是否行系统性淋巴结清扫的依据。

A clinicopathological study of resected non-small cell lung cancer with diameter≤2 cm

Objective:To investigate the clinicopathological features of surgical resection of non-small cell lung cancer(NSCLC) with diameter ≤2 cm.Methods:From 2010 to 2014，a total of one hundred and thirty-eight patients with non-small cell lung cancer of ≤2 cm or less in greatest diameter were operated on in our institution.The effect of surgical approach，lymph node involvement and histology on postoperative survival were retrospectively analyzed with clinicopathological data and postoperative follow-up.Results:The overall 5-year survival rate was 71.7%.Lymph node metastasis was found in 24 of 138(17.4%) patients.The 5-year survival rate for patients without lymph node metastasis was 82.7%，whereas it was 75.0% and 48.1% for those with pN1 and pN2 diseases(P＜0.05).Patients receiving lobectomy had a significantly better survival rate than patients receiving limited resection(P＜0.05).The 5-year survival rates for patients with stageⅠ，stage Ⅱ and stage Ⅲ were 89.8%，77.8% and 43.1%，respectively(P＜0.05).Conclusion:The survival of patients with non-small cell lung cancer with diameter ≤2 cm is closely related to the nodal involvement，stage of disease and surgical approaches.The indications for avoiding systematic lymph node dissection for operable NSCLC should not be based on the size of the tumor.