下咽癌颈淋巴结转移的临床病理学特点及其对预后的影响

Clinical pathology feature and prognostic factors of cervical lymph node metastases in hypopharyngeal carcinoma

目的 探讨影响下咽癌颈淋巴结转移的临床病理因素和颈淋巴结转移对预后的影响。方法 采用 χ2 检验和Logistic回归分析 ,对 98例下咽癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究。并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域等淋巴结病理学因素对生存率的影响 ,进行Cox回归分析。结果 下咽癌患者 5年生存率为 2 8 6 %。单因素和多因素分析均证实 ,肿瘤生长方式、肿瘤大小与发生颈淋巴结转移关系密切。而肿瘤突破基底膜达黏膜下层后对下咽癌颈淋巴结转移发生率不再产生进一步影响。Cox回归分析表明 ,临床N分期、颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结最低受累区域因素影响患者生存率 ,特别是转移颈淋巴结大小、转移颈淋巴结最低受累区域因素与下咽癌患者生存率明显相关。结论 下咽癌颈淋巴结转移是影响患者预后的重要因素 ,预测下咽癌颈淋巴结 ,对其作出早期正确诊断 ,并对影响预后的淋巴结因素采取相应治疗措施是提高下咽癌治疗效果的关键。

Objective To investigate the risk clinicopathological factors of primary tumor in the prediction of cervical lymph node metastases and the cervical lymph node prognostic factors in hypopharyngeal squamous cell carcinoma Methods A retrospective study was carried out to review the histopathological data from 98 hypopharyngeal squamous cell carcinoma patients The relationship between histopathological parameters and cervical lymph node metastases were evaluated by means of a univariate χ 2 test and multivariate stepwise logistic regression model And the Cox regression model was used to define possible pathological parameters of neck node affecting survival including N staging, presence of cervical lymph node metastases and extracapsular nodal spread, size and number of positive neck nodes, and levels of positive neck nodes Results The overall 5 year survival rate of patients with hypopharyngeal carcinoma was 28 6% In a univariate and multivariate analysis, it was confirmed that size and growth pattern of primary tumor correlated to cervical lymph node metastases In a multivariate Cox regression analysis, the most significant prognostic factors of cervical lymph node were the size of positive neck nodes and level involved Conclusions Cervical lymph node metastases were one of the most significant prognostic factors of hypopharyngeal carcinoma The identification of patients at risk for cervical lymph node metastases and the management of the neck by coping with pathological factors of cervical lymph node affecting survival are very important to improve the treatment and prognosis of hypopharyngeal carcinoma