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目的 探讨不同实性成分占比(CTR)及原发灶正电子发射断层显像/计算机断层扫描(PET/CT)代谢参数对指导cT_1N_0M0期非小细胞肺癌(NSCLC)患者纵隔淋巴结清扫范围的临床价值。方法 前瞻性连续纳入桂林医科大学第一附属医院收治的94例cT_1N_0M0期NSCLC患者，1∶1随机分为系统性纵隔淋巴结清扫(LND)组与选择性淋巴结采样(LNS)组，各47例；根据术前胸部CT图像测得的实性成分肿瘤比(CTR)将患者分为混合磨玻璃结节(mGGO,0.5≤CTR<1.0,n=11)与实性结节(SN,CTR=1.0,n=83)两个亚组。比较LND组和LNS组患者围手术期安全性、病理结局及无病生存期(DFS)。采用Cox比例风险回归模型评估影响DFS的因素。结果 LND组手术时间、术中出血量、胸腔引流时间、术后住院时间及术后并发症发生率均高于LNS组(均P<0.05)。两组间pN1检出率差异无统计学意义(17.02%vs.14.89%,P=0.778)；但CTR亚组间比较，SN组的气腔内播散、血管侵犯均高于mGGO组(均P<0.05)；术前淋巴结PET/CT参数均不能鉴别pN1状态(均P>0.05)。mGGO亚组中分别进行LNS与LND患者的30个月DFS率均为100%;SN亚组中LND的30个月DFS率优于LNS(83.33%vs.63.41%,Log-rank P=0.040)。Cox比例风险回归模型结果显示SN亚组中仅行LNS是影响DFS的独立危险因素(HR=3.425,P=0.016)；全队列中T＿TLG>24.71(HR=2.181,P=0.021)与气腔内播散(STAS)阳性(HR=2.542,P=0.005)也是影响DFS的独立危险因素。结论 cT_1N_0M0期NSCLC患者的淋巴结处理策略应依据CTR及代谢负荷个体化调整：0.5≤CTR<1.0的mGGO患者行LNS安全可行，可减少围手术期并发症；CTR=1.0且T＿TLG>24.71的SN患者须行LND以防早期复发。
Abstract：Objective To explore the clinical value of different consolidation-tumor ratio(CTR) and metabolic parameters of positron emission tomography/computed tomography(PET/CT) in guiding the extent of mediastinal lymph node dissection in patients with cT_1N_0M0 non-small cell lung cancer(NSCLC). Methods A prospective, consecutive study enrolled 94 patients with cT_1N_0M0 NSCLC admitted to the First Affiliated Hospital of Guilin Medical University. These patients were randomly divided into a systematic mediastinal lymph node dissection(LND) group and a selective lymph node sampling(LNS) group at a 1 ∶ 1 ratio, with 47 patients in each group. Based on the preoperative chest CT images, patients were further categorized into two subgroups: mixed ground-glass opacities(mGGO, 0.5 ≤ CTR<1.0, n=11) and solid nodules(SN, CTR=1.0, n=83), according to CTR. The perioperative safety, pathological outcomes, and disease-free survival(DFS) were compared between the LND and LNS groups. The factors influencing DFS were evaluated by Cox proportional hazards regression models. Results The operation duration, intraoperative blood loss, chest drainage duration, postoperative hospital stay, and postoperative complication rate in the LND group were all higher than those in the LNS group(all P<0.05). There was no statistically significant difference in the detection rate of pN1 between the two groups(17.02% vs. 14.89%, P=0.778); however, when comparing the CTR subgroups, the incidence of intrapulmonary dissemination, and vascular invasion in the SN group was higher than that in the mGGO group(all P<0.05); preoperative lymph node PET/CT parameters were unable to differentiate pN1 status(all P>0.05). In the mGGO subgroup, the 30-month DFS rate was 100% for both LNS and LND patients; in the SN subgroup, the 30-month DFS rate for LND was superior to that for LNS(83.33% vs. 63.41%, Log-rank P=0.040). The Cox proportional hazards regression model results indicated that performing only LNS in the SN subgroup was an independent risk factor affecting DFS(HR=3.425, P=0.016); in the full cohort, T＿TLG>24.71(HR=2.181, P=0.021) and STAS positivity(HR=2.542, P=0.005) were also independent risk factors affecting DFS. Conclusion The lymph node management strategy for patients with cT_1N_0M0 NSCLC should be individually adjusted based on CTR and metabolic burden: LNS is safe and feasible for patients with mGGO and a CTR of 0.5 to less than 1.0, which can reduce perioperative complications; LND is necessary for SN patients with a CTR of 1.0 and a T＿TLG greater than 24.71 to prevent early recurrence.
[1]Kariri Y A. Update on the treatment of non-small cell lung carcinoma(NSCLC)[J]. J Clin Med, 2025, 14(19):6960.
[2]Ji G, Luo W, Zhu Y, et al. Early-stage lung cancer detection via thin-section low-dose CT reconstruction combined with AI in nonhigh risk populations:a large-scale real-world retrospective cohort study[J]. Precis Clin Med, 2025, 8(2):pbaf007.
[3]宋剑南,叶伟,钱鹏,等.临床Ⅰ期非小细胞肺癌淋巴结切除策略的研究进展[J].临床肿瘤学杂志,2024,29(10):1033-1037.
[4]Hong Q, Wang Y, Xu M, et al. Balancing precision and quality of life:comparing systematic lymph node dissection and sampling in early-stage NSCLC through patient-reported outcomes[J]. Asian J Surg,2025, 48(9):5410-5418.
[5]Kim I H, Chong Y, Yun J K, et al. Analysis of lymph node metastasis based on consolidation tumor ratio and maximum standardized uptake value in clinical stage IA non-small cell lung cancer[J]. J Thorac Dis,2025, 17(2):944-958.
[6]Guo L, Wumener X, Du F, et al. The value of metabolic parameters on dynamic 18F-FDG PET/CT for predicting lymph node metastasis in non-small cell lung cancer[J]. Front Oncol, 2026, 16:1752947.
[7]Zhang Y, Deng C, Luo X, et al. Protocol of a single-arm, multicenter,phase Ⅲ trial for selective lymph node dissection in cT1N0M0 invasive non-small cell lung cancer with consolidation-tumor ratio>0.5located in the apical segment:Eastern Cooperative Thoracic Oncology Projects ECTOP-1018(SELLAS study)[J]. J Thorac Dis, 2024,16(11):8142-8148.
[8]Darling G E, Allen M S, Decker P A, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1(less than hilar)non-small cell carcinoma:results of the American College of Surgery Oncology Group Z0030 Trial[J]. J Thorac Cardiovasc Surg, 2011, 141(3):662-670.
[9]Sui Q, Yang H, Yin J, et al. The comparison of lobe-specific or systematic mediastinal lymph node dissection for early-stage lung adenocarcinoma with consolidation tumor ratio over 0.5[J]. Clin Lung Cancer, 2023, 24(1):51-59.
[10]Tian W, Yan Q, Huang X, et al. Predicting occult lymph node metastasis in solid-predominantly invasive lung adenocarcinoma across multiple centers using radiomics-deep learning fusion model[J]. Cancer Imaging,2024, 24(1):8.
[11]Aoki M, Kamimura G O, Tsuneyoshi Y, et al. Thorough lymphadenectomy impairs immunotherapy outcomes for postoperative intrathoracic recurrence of non-small cell lung cancer[J]. Anticancer Res, 2025, 45(9):3971-3981.
[12]Yin E, Sun N, He J. Tumor-draining lymph node-derived tumor-specific memory CD8+T cells:a key player in PD-1/PD-L1 immunotherapy[J].Signal Transduct Target Ther, 2023, 8(1):111.
[13]Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer(JCOG0802/WJOG4607L):a multicentre, open-label, phase 3, randomised,controlled, non-inferiority trial[J]. Lancet, 2022, 399(10335):1607-1617.
[14]Mimae T, Miyata Y, Tsubokawa N, et al. Lymph node dissection as a local control during segmentectomy for small-sized and radiologically solid dominant and pure solid tumors[J]. Jpn J Clin Oncol, 2025,55(11):1286-1291.
[15]Pan X, Xu W, Li Z, et al. Patterns and risk factors of lymph node metastasis in non-small cell lung cancer 2 cm or less[J]. J Thorac Dis, 2026, 18(1):6.
[16]Guglielmo P, Marturano F, Bettinelli A, et al. Additional value of PET and CT image-based features in the detection of occult lymph node metastases in lung cancer:a systematic review of the literature[J]. Diagnostics, 2023, 13(13):2153.
[17]Sun Y, Xiao L, Wang Y, et al. Diagnostic value of dynamic 18F-FDG PET/CT imaging in non-small cell lung cancer and FDG hypermetabolic lymph nodes[J]. Quant Imaging Med Surg, 2023, 13(4):2556.
[18]Obata T, Norikane T, Manabe Y, et al. Torso FDG-PET parameters as prognostic biomarkers for advanced non-small cell lung cancer patients undergoing first-line immunotherapy and chemotherapy[J].BMC Cancer, 2025, 25(1):1454.
[19]Wang Y, Lyu D, Fan L, et al. Advances in the prediction of spread through air spaces with imaging in lung cancer:a narrative review[J].Transl Cancer Res, 2023, 12(3):624.
基本信息:
中图分类号:R734.2
引用信息:
[1]王洋,覃石磊,郑民.具有不同实性成分占比的cT_1N_0M_0期非小细胞肺癌患者纵隔淋巴结清扫范围研究[J].临床肿瘤学杂志,2026,31(09):921-927.
基金信息:
广西壮族自治区卫生健康委员会西医类自筹经费科研课题（Z-C20230829）; 桂林市自筹经费科技项目（20220137z）
2026-09-28
2026-09-28