cN0声门上型喉癌的颈部复发相关因素分析

Neck Relapse-related Factors of cN0 Stage Supraglottic Cancer

背景与目的:声门上型喉癌的隐性淋巴结转移率高,是此类喉癌诊治的重点之一。本研究旨在探讨声门上型喉癌的隐性淋巴结转移的相关因素、预后及治疗情况。方法:回顾分析1992～1999年我科收治的cN0声门上型喉癌104例,对其隐性淋巴结转移率、转移淋巴结的分布、影响隐性淋巴结转移的因素及颈部处理等进行研究。结果:本组cN0声门上型喉癌隐性淋巴结转移率为23.1%(24/104),其中T2期23.9%(11/46),T3期30.8%(8/26),T4期18.5%(5/17)。隐性转移淋巴结主要位于病变侧Ⅱ、Ⅲ区(22/24)。出现隐性转移组预后差(log-rank=10.66,P=0.001)。切缘阳性影响隐性淋巴结转移率(χ2=10.015,P=0.002)。病理分化程度(χ2=3.349,P=0.175)、T分期(χ2=2.701,P=0.440)、原发灶处理方式(χ2=1.093,P=0.296)等对隐性淋巴结转移率影响差异无统计学意义。颈部选择性清扫能降低cN0声门上型喉癌隐性淋巴结转移率(χ2=4.070,P=0.044)。结论:cN0声门上型喉癌的隐性淋巴结转移主要位于病变侧Ⅱ、Ⅲ区;出现隐性淋巴结转移影响预后;切缘阳性影响隐性淋巴结转移率;对T1N0期喉癌颈部可观察,T2-4N0期喉癌行侧颈清扫(Ⅱ～Ⅳ区)是合理有效的。

BACKGROUND ＆ OBJECTIVE： The occult lymph node metastasis rate of supraglottic cancer is high, and the treatment of occult lymph node metastasis is important. This study was to explore the related factors, treatment, and prognosis of occult lymph node metastasis of supraglottic cancer. METHODS.. Clinical data of 104 patients with cNO supraglottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 1999, were retrospectively reviewed. The occult lymph node metastasis rate, distribution of metastatic lymph nodes, related factors, and treatment of the neck were analyzed. RESULTS： The occult lymph node metastasis rates were 23.1% （24/104） in the whole group, and 23.9% （11/ 46） in stage T2 patients, 30.8% （8/26） in stage T3, 18.5% （5/17） in stage T4. The metastatic lymph nodes mainly located at lateral levels Ⅱ - Ⅲ（22/24）. The prognosis of the patients with occult lymph node metastasis was poor （log-rank=10.66, P=0.001）. Positive margin increased occult lymph node metastasis rate （χ^2=10.015, P=0.002）, while pathologic differentiation （χ^2= 3.349, P=0.175）, T stage （χ^2=2.701, P=0.440）, and treatment of primary lesion （χ^2=1.093, P=0.296） had no effects on it. Selective neck dissection reduced occult lymph node metastasis rate （χ^2 =4.070,P =0.044）. CONCLUSIONS： The occult metastatic lymph nodes of cNO supraglottic cancer mainly locate at lateral levels Ⅱ- Ⅲ. The prognosis of the patients with occult lymph node metastasis is poor. Positive margin increases occult lymph node metastasis rate. For patients at stage T1N0, observation is enough; for patients at stage T2-4NO, lateral neck dissection （levels Ⅱ-Ⅳ） is effective.