颈淋巴结转移对硬腭鳞癌患者预后的影响

The Impact of Cervical Metastasis on the Prognosis of Squamous Cell Carcinoma of the Hard Palate

目的:评价颈淋巴结转移对硬腭鳞癌患者预后的影响。方法:对1964年至2001年在中山大学肿瘤防治中心住院治疗的127例原发于硬腭的鳞癌病例进行回顾性分析。颈淋巴结转移与否及N分期对生存率影响采用Kaplan-Meier法和Log-rank检验、结果:有颈淋巴结转移49例患者与无颈淋巴结转移78例患者5年生存率分别为17.59%和39.55%(P=0.043)。N_0～N_3期患者5年生存率分别为39.55%、22.79%、10.48%、0(P=0.037)。就诊时有颈淋巴结转移者49例(38.58%);就诊时无颈淋巴结转移患者经治疗后11例(8.66%)发生颈淋巴结转移,最终47.24%患者出现颈淋巴结转移。结论:有颈淋巴结转移的硬腭鳞癌患者预后差,且N分期越高预后越差。硬腭鳞癌有很高的颈淋巴结转移率,建议行选择性颈淋巴结清扫术。

Objective： To evaluate the impact of cervical metastasis on the prognosis of patients with squamous cell carcinoma of the hard palate. Methods： We reviewed the data of 127 cases of squamous cell carcinoma of the hard palate treated in our hospital between 1964 and 2004. Kaplan-Meier method and the log-rank test were used to analyze the im- pact of cervical lymph node metastasis and N-stage on patient survival. Results： The 5-year disease-specific survival rate of patients with cervical lymph node metastasis （49 cases） was 17.59% and that of patients without cervical lymph node metatasis （78 cases ） was 39.55% （P=0.043）. The 5-year disease-specific survival rates were 39.55%, 22.79%, 10.48%, and 0 for No, N1, N2 and N3 lesions, respectively （P=0.037）. Cervical lymph node metastasis was found in 38.58% （49 cases） of pa- tients with hard palate squamous cell carcinoma at first diagnosis. Of those who were not found with cervical lymph node metastasis at diagnosis, 11 cases （8.66%） were detected with cervical lymph node metastasis after therapy. Conclusion： Cervical lymph node metastasis is associated with low survival rate in patients with squamous cell carcinoma of the hard palate. Advanced N-stage is correlated with poor prognosis. Squamous cell carcinoma of the hard palate should be treated aggressively, and elective neck dissection should be considered because of the high rate of cervical metastasis.