NGHIÊN CỨU TÌNH TRẠNG DI CĂN NHẢY CÓC HẠCH TRUNG THẤT TRONG UNG THƯ PHỔI KHÔNG TẾ BÀO NHỎ GIAI ĐOẠN I-IIIA ĐƯỢC PHẪU THUẬT NỘI SOI TẠI BỆNH VIỆN K

Abstract

Introduction: Skip mediastinal lymph node metastasis (skip N2) refers to the phenomenon where mediastinal lymph node metastases occur without involvement of N1 nodes. This condition is generally considered to have a more favorable prognosis compared to sequential nodal metastasis. However, domestic data remain limited, especially in patients undergoing video-assisted thoracoscopic surgery (VATS). Materials and Methods: This was a retrospective descriptive study conducted on 123 patients with stage I-IIIA non-small cell lung cancer (NSCLC) who underwent VATS lobectomy with systematic lymph node dissection at K Hospital from January to December 2022. Lymph node status was classified into four groups: no nodal metastasis, N1-only metastasis, skip metastasis (pN0N2), and sequential metastasis (pN1N2). Clinical, histopathological, and radiological characteristics were compared between the skip metastasis and non-skip metastasis groups. Results: The incidence of skip N2 metastasis was 7.3% of all patients and accounted for 42.8% of those with N2 involvement. Skip metastasis was significantly associated with tumor size >3 cm (p = 0.033). Other factors such as upper lobe location, adenocarcinoma histology, and visceral pleural invasion showed a trend toward association but did not reach statistical significance. VATS with systematic lymphadenectomy demonstrated a good ability to detect skip metastases. Conclusion: Skip mediastinal lymph node metastasis is not uncommon and is generally associated with a better prognosis than sequential metastasis. Larger tumor size is significantly associated with an increased risk of skip metastasis. Other factors potentially related to skip N2 metastasis include upper lobe tumor location, adenocarcinoma histology, and visceral pleural invasion, although these were not statistically significant in this study.