喉癌临床NO级颈淋巴结转移的特点

Characteristic of cervical lymph node metastasis in patients with clicinal NO laryngeal carcinoma

目的探讨喉癌NO分级颈淋巴结转移的临床、病理特点,为cNO分级喉癌患者治疗提供依据。方法回顾性分析47例cNO级喉癌患者颈淋巴结转移的临床、病理资料,并对其颈淋巴结转移时间、转移部位和转移颈淋巴结包膜外浸润等情况进行统计分析。结果21例喉声门型癌平均转移时间为11.6个月,26例喉声门上型癌为20.6个月,差异无显著性(P=0.162)。T3、T4喉癌平均转移时间为15.8个月,T2喉癌平均转移时间为17.5个月,Mann-Whitney非参数秩和检验差异有显著性(P=0.002)。90.4％颈淋巴结转移部位集中于Ⅱ～Ⅲ区,无Ⅴ区、Ⅵ区转移。80.8％的喉声门上型癌转移淋巴结发生包膜外侵犯,喉声门型癌转移淋巴结发生包膜外侵犯率为52.4％,差异有显著性(P=0.038)。转移性淋巴结包膜外侵犯组平均转移时间21.2个月,非包膜外侵犯组为6.7个月,f检验两者差异有显著性(t=2.65,P=0.012)。结论cNO级喉癌颈淋巴结转移多集中于Ⅱ～Ⅲ区：T3、T4喉癌转移时间较T2喉癌早；喉声门上型癌转移淋巴结较喉声门型癌容易发生淋巴结包膜外侵犯：颈淋巴结转移被发现越晚,越容易发生淋巴结包膜外侵犯。

OBJECTIVE To study the clinical and pathological characteristic of cervical lymph node metastasis in patients with clinical NO laryngeal carcinoma and its implications for treatment of clinical NO laryngeal carcinoma. METHODS 47 patients with delayed lymph node metastasis of laryngeal carcinoma were retrospectively reviewed, statistic analysis of its duration of metastasis, its lymph node distribution and lymph node amalgamation were done. RESULTS The time of delayed cervical metastasis in 21 patients with glottic carcinoma was 11.6 months in average, while 20.6 months in average in 26 patients with supraglottic carcinoma, there＇s no statistical difference （P=0.126）. The time of delayed cervical metastasis in T3 and T4 was 15.8 months in average ,17.5 months in T2 in average, there＇s statistical difference with Mann-Whitney test （P=-0.002）,the time of delayed cervical metastasis in T3 and T4 was earlier than T2. 90.4%（47/52） of cervical metastasis were located in level Ⅱ～Ⅲ, while no metastasis were found in level Vand level Ⅵ. 80.8 % of patients with supraglottic carcinoma and 52.4 % of patients with glottic carcinoma had lymph node amalgamation, there＇s statistical difference（P=0.038）.The average metastasis time in amalgamation group was 21.2 months, while it was 6.7 months in the group without amalgamation,statistical difference was found with t-test（t=2.65,P=0.012）. CONCLUSION The delayed lymph node metastasis in cN0 laryngeal carcinoma were mostly located in level Ⅱ～Ⅲ; the time of delayed cervical metastasis in T3 and T4 was earlier than that of T2; the lymph node of delayed cervical metastasis was more prone to be amalgamation in supraglottic carcinoma patients; the later metastasis of lymph node to be discovered ,the more prone to be amalgamation.