颈清扫术治疗晚期颈转移癌的远期效果及复发相关因素分析

Efficacy of radical neck dissection for advanced cervical nodal metastases

目的探讨颈清扫术治疗晚期颈转移癌的远期效果及术后颈部复发的相关影响因素。方法对112例接受全颈清扫手术的头颈部鳞状细胞癌N2、N3患者,利用手术标本病理检查及随访资料进行回顾性分析。结果晚期颈转移癌全颈清扫术后5年颈部复发率为277%(31/112),其中N2、N3患者的术后5年颈部复发率分别为165%(13/79)、545%(18/33)。31例全颈清扫术颈部复发患者,KaplanMeier法统计术后3年生存率、5年生存率分别为161%(5/31)、97%(3/31)。单因素χ2分析显示,临床N分期、病理颈淋巴结大小、转移淋巴结包膜外扩散、颈部非淋巴组织结构受侵情况与术后颈部复发有关。多因素Logistic回归分析结果表明,仅病理检查颈淋巴结大小与术后颈部复发明显相关。结论颈部复发是晚期颈转移癌患者最常见的术后肿瘤复发原因。转移颈淋巴结大小是全颈清扫术后颈部复发根本和决定性影响因素。而临床N分期、转移淋巴结包膜外扩散、颈部非淋巴组织结构受侵情况对全颈清扫术后颈部复发具有重要影响。

Objective To investigate the efficacy of radical neck dissection (RND) to control advanced cervical nodal metastases and analyze the risk factors related with cervical recurrence in head and neck cancer. Methods One hundred and twelve patients with N2, N3 head and neck cancer were treated by RND were retrospectively reviewed and the pathological specimen were restudied. Results Five-year cervical recurrence rate of patients with advanced nodal metastases after RND is 27.7% (31/112), and 16.5%(13/79), 54.5%(18/33) in N2, N3 respectively. The overall 3-year, 5-year survival rate of patients with cervical recurrence after RND was 16.1%(5/31), 9.7%(3/31) respectively. In a univariate χ2 analysis, it was confirmed that the following variables correlated to cervical recurrence, i.e., clinical N staging, size of positive neck nodes, presence of extracapsular nodal spread and invasion of nonlymphatic structures. In a multivariate logistic regression analysis, the most significant risk factor for cervical recurrence was the size of positive neck nodes. Conclusions Cervical recurrence is one of the most common reasons for tumor recurrence of head and neck cancer. The size of positive neck nodes is the key risk factor in determining the development of cervical recurrence in patients of advanced cervical nodal metastases after RND. Patients with presence of extracapsular nodal spread and invasion of nonlymphatic structures have high risk of developing cervical recurrence.