Bedeutung der pulmonalen Lymphknotenmetastasierung bei lokal fortgeschrittenen, nicht-kleinzelligen Bronchialkarzinomen

Zusammenfassung

Hintergrund: Das lokal fortgeschrittene (T3 - 4) nicht-kleinzellige Bronchialkarzinom mit pulmonalen Lymphknotenmetastasen (N1) beinhaltet unterschiedliche Tumormanifestationen, die verschiedenen lymphatischen Metastasierungsmustern und möglicherweise Prognosen entsprechen. Patienten und Methode: Retrospektiv wurden die Krankenblätter und Verlaufsunterlagen der 181 Patienten mit pathologischem Tumorstadium IIIA-pT3N1 und IIIB-pT4N1 erfasst, die im Zeitraum 1990 - 1995 operiert wurden. Der Altersmedian betrug 62 Jahre (Bereich: 34 - 80 Jahre). Ergebnisse: Nach 188 resektiven Eingriffen betrug die 30-Tage-Letalität 3,7 %. Die folgende Analyse betrifft die 181 überlebenden Patienten, wobei 110 (60,8 %) Pneumonektomien und 71 (39,2 %) Lobektomien/Bilobektomien durchgeführt wurden. Das pathologische Stadium nach der UICC-Klassifikation 1997 lautete T3N1 in 128 (70,7 %) und T4N1 in 53 (29,3 %). Ein metastatischer Befall der hilären, interlobären und lobären Lymphknoten wurde in 44 (24,3 %), 17 (9,4 %) bzw. 27 (14,9 %) Patienten nachgewiesen, eine direkte Lymphknoteninfiltration in 93 Patienten (51,4 %). Die 3-, 5- und 10-Jahres-Überlebensraten nach Kaplan-Meier betrugen für N1 hilär 23 %, 13 % und 8 %, für N1 interlobär 18 %, 6 % und 0 %, für N1 lobär 48 %, 37 % und 22 %, und für N1 direkt 32 %, 27 % und 21 %. Der Befall der hilären Lymphknoten korrelierte mit einer eindeutig ungünstigeren Prognose (p = .0366). Schlussfolgerungen: Die metastatische Absiedlung in hiläre Lymphknoten bei lokal fortgeschrittenem NSCLC kann prognostisch als initiale N2-Erkrankung betrachtet werden und erfordert eine entsprechende Behandlung. Die direkte Infiltration der pulmonalen Lymphknoten erscheint prognostisch weniger ungünstig für die betroffenen Patienten.

Abstract

Background. The locally advanced (T3 - 4) non-small cell lung cancer with pulmonary lymph node metastases (N1) is a mixture of different subgroups of disease with varying pattern of tumor extension and long-term survival rates. Patients and methods: We retrospectively reviewed hospital records and follow-up data of 181 patients operated on between 1990 and 1995 with pathological stage IIIA-pT3N1 and IIIB-pT4N1. Median age was 62 years (range 34 - 80). Results: The operative mortality was 3.7 %. The analysis was carried out on the 181 hospital survivors. The operative procedure was a pneumonectomy in 110 cases (60.8 %) and a lobectomy/bilobectomy in 71 (39.26 %). The pathological stage according to the UICC TNM-Classification of 1997 was T3N1 in 128 (70.7 %) and T4N1 in 53 (29.3 %). We observed a metastatic involvement of the hilar, interlobar and lobar lymph nodes in 44 (24.3 %), 17 (9.4 %), and 27 (14.9 %) patients, respectively, whereas a direct infiltration in 93 patients (51.4 %). The actuarial overall 3-, 5- and 10-year survival rates for N1 hilar was 23 %, 13 % and 8 %, for N1 interlobar was 18 %, 6 % and 0 %, for N1 lobar was 48 %, 37 % and 22 %, and for N1 direct was 32 %, 27 % and 21 %, respectively. The involvement of hilar lymph nodes correlates with a worse prognosis (p = .0366). Conclusions: Metastases to the hilar lymph nodes in locally advanced NSCLC can be considered an initial N2-disease and should be treated correspondingly. Lymph node involvement by direct invasion is associated with a relatively more favourable prognosis for the patients.

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