口腔鳞癌浸润方式与颈淋巴结转移关系的组织学研究

The Histological Research between the Mode of Invasion and Cervical Lymph Node Metastasis in Squamous Cell Carcinoma of the Oral Cavity

目的 探讨口腔鳞癌不同浸润方式和颈淋巴结转移的关系。方法 利用Yamamoto的浸润方式分型法,对 200例临床和病理资料完整的口腔鳞癌患者进行组织学回顾性研究和分析。结果 鳞癌的浸润方式与鳞癌的颈淋 巴结转移明显相关(P<0.001)。Ⅰ型～Ⅳd型浸润方式相对应的颈淋巴结转移率分别为0、5.9%、14.3%、63.0% 和82.9%。在80例Ⅲ～Ⅳd型浸润方式的转移患者中,Ⅳd型浸润方式常伴随N2期转移(P<0.05),而Ⅲ型和Ⅳc 型浸润方式则更常伴有N1期转移(P<0.05)。Ⅳc型浸润有41.2%的Ⅰ级平面和79.4%的Ⅰ～Ⅱ级平面转移机 率,而Ⅳd型浸润的转移平面较为弥散,两者间有显著性差异(P<0.05)。结论 不同的口腔鳞癌浸润方式有着截 然不同的颈淋巴结转移机率、转移分期和转移平面。对口腔鳞癌原发灶肿瘤-宿主边缘浸润方式的分型研究,有 助于判断口腔鳞癌的区域性淋巴结转移情况,提供临床治疗方案设计和预后预测的依据。

Objective The relationship between the mode of tumor invasion in the tumor-host borderline and the frequency of cervical lymph node metastasis was investigated in squamous cell carcinoma of the oral cavity.Methods 200 cases with histologically proven squamous cell carcinoma of the oral cavity were studied by histological method with HE stained. The mode of invasion in the tumor-host relationship was classified into five grades by Yamamoto′s criteria.Results With regard to the relationship between the mode of invasion and metastasis, the more invasive the tumor tissue was, the more frequent the metastasis formed (P<0.001). The frequency of metastasis in grades 1 and 2 was low (0 and 5.9%, respectively),The frequency of metastasis in grades 3 was moderate (14.3%), and that in grades 4c and 4d was highly rapid (63.0% and 82.9%, respectively). Single node metastases were frequent in grade 3 and grade 4c (66.7% and 58.8%, respectively), while plural node metastases were frequent in grade 4d (70.6%, P<0.05 ). Moreover, the distribution of metastasized lymph nodes was focused on level 1 (41.2%)or level 1 and 2 (79.4%) in grade 4c and was dispersed from level 1 to 4 in grade 4d (P<0.05). In the present study, the degree of differentiation did not correlate well with the frequency of metastasis.Conclusion These results indicate that the more invasive the tumor cells were to the host, the more frequent the metastasis formed. The different mode of invasion would accompany with different frequency of metastasis, different number and distribution of metastasized lymph nodes.