舌体鳞状细胞癌cN0患者的颈淋巴结转移临床分析

Clinical study of occult cervical lymph node metastases on patients with tongue squamous cell carcinoma

目的分析临床颈部阴性(cN0 )的舌体鳞状细胞癌隐匿性颈淋巴结转移率和与转移相关的临床因素,探讨cN0患者的颈部治疗原则。方法回顾性分析94例cN0舌癌患者的临床和病理资料,探讨隐匿性转移的发生率和转移规律。结果94例cN0舌癌中,病理检查证实颈淋巴结转移者39例,其中T1～T4期肿瘤的转移率依次为2 8.6 % ,35 .0 % ,5 6 .5 %和6 0 .0 %。高分化和中低分化舌癌的转移率分别为2 3.1%和5 4 .6 %。原发灶生长方式为外突型、溃疡型和浸润型病变的转移率依次为13.3% ,2 7.3%和6 0 .8%。单个淋巴结转移者19例,多个淋巴结转移(累及一个或多个颈部分区)者2 0例。共有5 5个颈部分区检出阳性淋巴结,各区转移频率依次为Ⅰ区,32 .7% (18/ 5 5 ) ;Ⅱ区,4 1.8% (2 3/ 5 5 ) ;Ⅲ区,2 3.6 % (13/ 5 5 ) ;Ⅳ区,1.8% (1/ 5 5 ) ,未见累及Ⅴ区者。结论①原发灶的病理分级和生长方式可以作为术前判断颈淋巴结转移的参考因素。②高分化的T1期病变可行颈部观察,但对于分化程度较低、生长方式呈浸润型或溃疡型者宜行选择性颈淋巴清扫术。T2～T4期病变须行同期选择性颈淋巴清扫术。③建议对cN0舌癌行扩大性肩胛舌骨上颈淋巴清扫(清扫Ⅰ～Ⅳ区) ,避免全颈淋巴清扫术给患者造成的损害。

Objective To investigate the relationship between occult cervical lymph node metastases in mobile tongue squamous cell carcinoma and the clinicopathological parameters of the primary tumor and to disscuss the treatment approach for patients with cervical lymph node for cN0 squamous cell carcinoma of the tongue.Methods The clinical and histopathologic records of 94 cases of mobile tongue carcinoma with cN0 neck were retrospectively analyzed. All cases, 57 males and 37 females aged 22 to 80 years, were treated with surgical procedures during January of 1998 to December of 2003.Results Among the 94 cases, 39 of them (~41.5% ) were confirmed as the cervical metastases by histopathologic evaluation. The rate of occult cervical metastases in T1, T2, T3, and T4 stage was ~28.6% , ~35.0% , ~56.5% , and ~60.0% , respectively. The cervical metastasic rate of well-differentiated carcinoma was ~23.1% compared to ~54.6% in the moderate or poorly differentiated carcinoma. For the groups of exogenous, ulcerative and infiltrative types, the rates of occult metastases was ~13.3% , ~27.3% , and ~60.8% , respectively. Single lymph node metastases were found in 19 cases; multiple lymph nodes metastases in 20 cases. The cervical lymphatic metastatic rate was ~32.7% (18/55) in level Ⅰ, ~41.8% (23/55) in level Ⅱ, 23.6% (13/55) in level Ⅲ, and ~1.8% (1/55) in level IV, respectively. Cervical lymphatic metastases were not found in level V.Conclusion ①There was a significant correlation between the gross appearance and the degree of differentiation of the primary tumor and the occult cervical metastases rate. These parameters can be used for the prediction of occult cervical lymph node metastases in mobile tongue squamous cell carcinoma.②Well differentiated T1N0 carcinomas should be closely followed-up. Elective neck dissection should be performed in T1 lesions with moderate to poor differentiations or with infiltrative or ulcerative lesions. Patients with T2～T4N0 carcinomas should receive elective neck dissection.③Extended supraomohyoid neck dissection, including levels I to IV, is feasible for patients with cN0 tongue carcinoma.