头颈部鳞状细胞癌双侧颈淋巴转移的临床病理学特点和相关因素分析

Clinicopathologic features and risk factors of bilateral cervical lymph node metastasis in head and neck squamous cell carcinoma

目的：探讨头颈部鳞状细胞癌（head and neck squamous cell carcinoma ，HNSCC）患者发生双侧颈淋巴转移的临床病理学特点及其相关影响因素。方法选择最易发生双侧颈淋巴转移的3种常见HNSCC共计286例（舌癌83例，下咽癌101例，声门上型喉癌102例），术后病理证实至少一侧或双侧发生颈淋巴转移。采用病理学手段对手术切除的原发肿瘤标本和颈清扫标本进行系统研究，纳入观察的肿瘤原发灶相关临床病理学因素包括肿瘤T分期、部位、大小、是否越过中线、病理分级、生长方式、侵犯程度；纳入观察的颈淋巴结临床病理学因素包括N分级及肿瘤主体侧（同侧）转移淋巴结大小、数目、受累分区数、淋巴结破膜（ extracapsular spread ，ECS）。χ2检验及Logistic回归进行数据资料统计分析。结果286例颈淋巴转移的HNSCC 患者中，双侧颈转移的发生率为30.1％（86/286），对侧隐匿转移的总体发生率为18.2％（52/286）；双侧颈转移的发生率由高到低依次为下咽癌35.6％（36/101）、声门上型喉癌31.4％（32/102）、舌癌21.7％（18/83）。在颈淋巴结病理学因素中，N分级和同侧转移淋巴结数目、受累分区数及ECS与双颈转移有关。多因素回归分析显示，肿瘤是否越过中线是舌癌双颈转移的重要影响因素，而肿瘤是否越过中线、同侧转移淋巴结ECS是下咽癌、声门上型喉癌双颈转移的重要影响因素。在肿瘤原发灶相关临床病理学因素中，T分期、肿瘤大小及是否越过中线与舌癌双颈转移有关；T分期及肿瘤是否越过中线与下咽癌双颈转移有关；声门上型喉癌双颈转移仅与肿瘤是否越过中线有关。结论肿瘤是否越过中线是导致舌癌、下咽癌及声门上型喉癌双颈转移最重要和共同的原发肿瘤影响因素，而同侧转移淋巴结ECS是影响下咽癌及声门上型喉癌双颈转移的重要因素。

Objective To investigate the clinicopathologic features and associated risk factors for bilateral neck node metastasis （ BNM ） in head and neck squamous cell carcinoma （ HNSCC ）.Methods Two hundred eighty-six cases with HNSCC were retrospectively studied , including 83 cases of oral tongue cancers, 101 cases of hypopharyngeal cancers and 102 cases of supraglottic laryngeal cancers.All patients had unilateral or bilateral cervical lymph node metastasis confirmed by postoperative pathologic examinations .The following factors were evaluated to determine the risk for BNM in HNSCC： T staging, size, location, trans-midline condition, growth pattern, pathologic grading and infiltration of primary tumors;N staging;the size, number and extracapsular spread （ECS） of ipsilateral metastatic nodes;the number of involved levels on the ipsilateral neck.Chi-square test and logistic regression test were used for statistical analysis.Results BNM was found in 86 （30.1%） of 286 patients with HNSCC, including 52 （18.2%） cases of contralateral occult neck node metastasis.The incidence of BNM was 35.6% （ 36/101 ） in hypopharyngeal cancer , 31.4% （32/102） in spuraglottic laryngeal cancer and 21.7%（18/83） in oral tongue cancer , respectively.N staging, the number and ECS of ipsilateral metastatic nodes , and the number of involved levels on the＆amp;nbsp;ipsilateral neck were important factors contributing to BNM.Multiple logistic regression analysis revealed that midline passing of primary tumor was associated with BNM in oral tongue cancer.The midline passing and ECS of ipsilateral metastatic node were key factors for BNM in hypopharyngeal and supraglottic laryngeal cancers.T staging, size and midline passing of primary tumor were closely related to BNM in oral tongue cancer.T staging and midline passing were associated with BNM in hypopharyngeal cancer.Midline passing was an important factor related to BNM in supraglottic laryngeal cancer.Conclusion Midline passing of primary tumor is the most important factor determining BNM in hypopharyngeal , supraglottic laryngeal and oral tongue cancers , whereas ECS of ipsilateral metastatic node is the most important factor impacting BNM in hypopharyngeal and supraglottic laryngeal cancers.