Background: In clinical Ia (cT1N0M0) patients, some may have poor prognosis, for it might occur pathologic N1 (pN1) or N2 (pN2) postoperatively. The aim of this study is to determine the radiologicaland pathological factors related to clinical Ia adenocarcinoma.
Methods: The retrospective study was conducted on 297 clinical Ia adenocarcinoma patients resected at our hospital between May 2012 to December 2016. The clinical profiles, radiological and pathological features were analyzed between nodal upstaging group and non-upstaging group.
Results: Of 297 patients treated for cN0 tumors, 250 cases (84.2%) were confirmed postoperatively as having pN0 tumors, and 47 (15.8%) were confirmed as having pN1 or pN2 tumors. Female, low smoking index, micropapillary predominant and solid predominant adenocarcinoma, puresolid tumor and large tumor size were all more frequently seen in the nodal upstaging group than in the pN0 group (P<0.05). Logistic regression indicate that radiological solid tumor, micropapillary predominant and solid predominant adenocarcinoma and vessel invasionare the risk factors of nodal upstaging in clinical Ia adenocarcinoma.
Conclusions: Radiological solid tumors, micropapillary predominant and solid predominant adenocarcinoma andvessel invasion are risk factors for nodal upstaging for early stage lung cancer. Radiological solid tumors should perform SLND in Ia adenocarcinomas.
【中文题目：临床Ia期肺腺癌N分期上调的危险因素】 【中文摘要：背景与目的 即使是临床Ia（cT1N0M0）期肺腺癌的患者，部分预后也相对较差，这可能与术后病理学淋巴结转移而导致的N升期有关。本研究旨在分析影响临床早期肺腺癌N分期上调的影像学及病理学因素。方法 回顾性研究2012年5月-2016年12月于我院行手术治疗的297例临床Ia期肺腺癌的患者，分析N分期上调组及非上调组的临床一般资料、影像学及病理学资料的差异。结果 297例cN0肺腺癌中，250例（84.2%）被证实为pN0，47例（15.8%）被证实为pN1和pN2。其中，女性、吸烟史、脉管癌栓、微乳头和实体为主病理亚型的肺腺癌以及影像学中纯实性结节等，均是N分期上调的影响因素（P<0.05）。Logistic回归分析表明：影像学中实性肿瘤、微乳头及实体为主型腺癌和脉管癌栓是临床Ia期腺癌的出现N分期上调的独立危险因素。结论 病理学脉管癌栓、微乳头和实体为主的肺腺癌以及影像学中纯实性结节是Ia期肺腺癌N分期上调的独立危险因素。临床Ia期的肺腺癌其影像学表现为纯实性结节时，应进行系统性淋巴结清扫。】 【中文关键词：肺肿瘤；临床早期；N分期；影像学；病理学】.
Keywords: Clinical early stage; Lung neoplasms; N upstaging; Pathology; Radiology.