60例原发灶不明的颈转移性鳞癌的放射治疗

Radiation treatment of 60 patients with cervical lymph node metastatic squamous cell carcinoma from an unknown primary site.

目的 探讨颈淋巴结的临床分期和不同大小的放射治疗野对原发灶不明的颈转移性鳞癌的预后影响。方法 回顾性分析本院 1989年 1月至 1997年 12月间收治的 6 0例原发灶不明的颈转移性鳞癌 (不包括锁骨上区转移者 )的临床资料。结果 全组病例 5年总的生存率为 6 8.5 % ,其中N1 ,N2 和N3 病例的 5年生存率分别为 10 0 %、6 8.0 %和 40 .9% (χ2 =7.2 9,P =0 .0 2 6 ) ,而单侧颈部 ,全颈部和扩大野照射者的 5年生存率分别为 6 6 .5 %、74.5 %和 5 4.6 % (χ2 =1.38,P =0 .5 0 1)。Cox比例风险模型分析发现颈淋巴结分期对生存率的影响有显著性意义 (P =0 .0 32 )。 5年颈部局部控制率为6 5 .6 % ,其中N1 、N2 和N3 病例的 5年局部控制率分别为 10 0 %、6 3.2 %和 34 .6 % (χ2 =5 .5 1,P =0 .0 6 4) ,而单侧颈部、全颈部和扩大野照射者的 5年局部控制率分别为 87.6 %、5 1.0 %和 72 .7% (χ2 =2 .5 5 ,P=0 .2 79)。 5年原发病灶的出现率为 2 1.2 % ,小野 (单侧颈部或全颈部照射 )和扩大野照射的 5年原发灶出现率分别为 2 3.3%和 12 .5 % (χ2 =0 .5 2 ,P =0 .46 9)。结论 颈淋巴结的临床分期是影响生存率的重要预后因素 ,并且随着期别的升高 ,颈部局控率有下降的趋势 ;小野较扩大野照射的原发灶出现率有增?

Objective To evaluate the prognosis for patients with squamous cell carcinoma of cervical lymph node metastases from an unknown primary site who had different clinical stages and were irradiated to different fields. Methods The clinical date of 60 patients with cervical lymph node metastatic squamous cell carcinoma from an unknown primary site(no including patients with supraclavicular node metastases) were retrospectively analyzed. Results The overall 5-year survival rates(OSR) was 68.5%, the OSR of patients with N 1,N 2 and N 3 stage were 100%, 68.0% and 40.9% respectively(χ 2=7.29,P=0.026). The OSR of patients with one lateral neck, whole neck and large fields irradiation were 66.5%, 74.5% and 54.6% respectively(χ 2=1.38,P =0.501). The Cox proportional hazard model showed that clinical stages of cervical lymph node had an significant effect in patients survival(P=0.032). The 5-year local control rates(LCR) 65.6%, the LCR of patients with N 1,N 2 and N 3 stage were 100%, 63.2% and 34.6% respectively(χ 2=5.51, P=0.064). The LCR of patients with one lateral neck, whole neck and large fields irradiation were 87.6%, 51.0% and 72.7% respectively(χ 2=2.55, P =0.279). The 5-year subsequent appearance rates of occult primary cancer(SAR) was 21.2%, the SAR of patients irradiated by small(one lateral neck or whole neck) and large fields were 23.3% and 12.5% respectively(χ 2=0.52, P =0.469). Conclusions The clinical stages of cervical lymph node is an important prognostic factor for survival and the local control rates has a decreasing trend as the stage increases. The subsequent appearance rates of occult primary cancer of patients irradiated by small fields has a higher trend than its of patients irradiated by large fields, but the control rates and survival rates have no significant difference in different fields irradiated.