喉声门上型癌颈淋巴结转移包膜外侵犯的频度和预后

Frequency and prognosis of extracapsular spread in neck metastasis in supraglottic carcinomas

目的为研究喉声门上型癌同侧颈淋巴结转移包膜外侵犯的频度和预后。方法总结1994年1月～1997年12月期间177例同期行经典性或改良性颈清扫术喉声门上型癌病例。采用透明淋巴结摘出连续切片法处理颈清扫标本。采用SPSS11.5软件进行统计学分析,生存分析采用Kaplan-Meier法,结果用Log-Rank方法进行检验。结果81例标本有颈淋巴结转移,转移率为45.8%,其中32例淋巴结包膜外侵犯,其频度为39.5%(32/81)。颈淋巴结转移包膜外侵犯与病理N分级、同侧转移淋巴结个数相关。包膜外侵犯的病例同侧颈部复发率和对侧颈部转移率比无包膜侵犯的病例高。颈部淋巴结转移无包膜侵犯和包膜外侵犯病例的5年生存率分别为61.9%和22.2%,差异有统计学意义。结论淋巴结转移包膜外侵犯影响患者预后,淋巴结转移包膜外侵犯病例的对侧转移率高,未行同期双侧颈清扫者,应密切随访观察对侧颈部状况。

OBJECTIVE To study the frequency of extracapsular spread （ECS） in neck metastasis and its impact on prognosis in supraglottic carcinoma. METHODS A total of 177 patients with radical or modified neck dissection between Jan. 1994 and Dec. 1997 for supraglottic carcinoma were summarized. Transparent lymph node detection and a series of sectioning method were applied on all neck dissection specimens. The SPSS software package （version 11.5） was used to make statistical analysis. Survival curves were calculated with the Kaplan-Meier model. Impact of extracapsular spread on prognosis was assessed for significance with the Log-Rank test. RESULTS Eighty one patients were pathologically positive in neck specimens and the neck metastatic rate was 45.8 %. ECS was found in 32 cases and the ECS frequency was 39.5 % （32/81）. The ECS was related with pathological N stage and the number of positive nodes. Patients with ECS had a higher possibility of regional recurrence and contralateral metastasis. The 5-year survival rates of patients with neck metastasis ECS- and patients with ECS＋ were 61.9 % and 22.2 % respectively. The differences had statistically significance. CONCLUSION ECS in neck metastasis affects the prognosis in patients with supraglottic carcinoma. If bilateral neck dissection was not selected simultaneously, close follow-up on contralateral neck should be selected in patients with ECS because of a higher incidence of contralateral neck metastasis.