上颌鳞癌的颈淋巴转移与预后分析

Cervical metastases and prognosis of oral maxillary squamous cell carcinoma: A retrospective study

目的：评估上颌鳞癌的颈淋巴转移情况并分析预后,探讨恰当的治疗方式。方法：回顾2002-1-2011-12间南京大学医学院附属口腔医院收治的67例硬腭及上颌牙龈鳞癌患者资料,研究颈淋巴转移和隐匿性转移的发生率及预后情况,分析临床病理因素对颈淋巴转移及预后的影响,然后提出治疗建议。结果：颈淋巴转移及隐匿性转移发生率分别为17.2%（11/64）和9.8%（5/51）。pT分期和脉管侵犯显著影响颈转移发生率。pT4期患者的隐匿性转移风险较高。单因素与多因素生存分析发现颈淋巴转移显著降低患者的五年预期生存率。结论：上颌鳞癌的颈淋巴转移与T分期显著相关。建议对T4期患者行选择性颈淋巴清扫（END）,而T1-T3期患者可以选择术后随访观察。

Objective： To investigate the incidence of cervical metastasis of oral and maxillary squamous cell carcinoma（SCC） and to define its impact factors. Methods： A retrospective study of patients with SCC of hard palate and maxillary alveolus treated by surgery from 2002 to 2011. Results： The incidences of cervical metastasis and occult metastasis were 17. 2%（11 /64） and 9. 8%（5 /51） respectively. pT classification and vascular invasion were correlated with cervical metastasis. Occult metastatic risk was significantly higher in pT4 patients. Presence of positive nodes impaired prognosis significantly. Conclusion： Overall and occult metastasis of oral and maxillary SCC were highly associated with pT classification. Routine and synchronous elective neck dissection（END） is recomend for the treatment of T4 lesions while observation is alternative for T1- T3 lesions.