cT_(1-2)N_0M_0口腔鳞状细胞癌隐匿性淋巴转移规律及相关因素分析

Analysis of the rule of occult lymphatic metastasis and its related factors in clinical T_(1-2)N_0M_0 oral squamous carcinoma

目的研究c T1-2N0M0口腔鳞状细胞癌（OSCC）患者隐匿性淋巴转移（OLM）规律及相关因素,为此类患者颈部处理提供参考。方法回顾性分析中山大学附属口腔医院口腔颌面外科232例c T1-2N0M0OSCC病例资料。根据隐匿性淋巴结分布探讨其转移规律,Log-rank及Cox回归比例模型分析其对预后的影响,Kaplan-Meier法绘制OLM患者的生存曲线。单因素分析（卡方检验）OLM的相关因素,对有统计学意义者进行多因素Logistic回归分析。结果 232例患者中46例发生OLM,以Ⅱ区最多（42.9%）,Ⅰ区次之（31.7%）,其次是Ⅲ区（19.0%）。Cox多因素分析显示OLM是影响患者预后的重要因素,OLM患者5年总生存率（OS）、疾病特异性生存率（DSS）和无复发生存率（RFS）分别为63.0%、73.9%、56.5%,显著低于无OLM患者（χ2OS=45.0、χ2DSS=31.2、χ2RFS=58.6,P均〈0.05）。单因素分析显示,肿瘤生长方式、浸润程度及肿瘤生长时间与OLM相关,多因素Logistic回归分析显示肿瘤浸润程度（Wald=13.0,P=0.001）及肿瘤生长时间（Wald=7.9,P=0.049）与OLM密切相关,其中侵犯肌层及生长时间1年以上为OLM的预测因素,其OR值分别为6.0和4.6。结论Ⅰ~Ⅲ区是隐匿性淋巴结的主要分布区域。对于c T1-2N0M0OSCC,肿瘤生长1年以上或侵犯肌层的患者更容易发生OLM,是选择性颈淋巴结清扫术的参考因素。

Objective The aim of the study was to investigate the rule of occult lymphatic metastasis（OLM） in clinical T1-2N0M0 oral squamous cell carcinoma（OSCC） and its related factors to provide clinical bases for the neck management. Methods This retrospective study included 232 consecutive clinical T1-2N0M0 OSCC patients between January 2000 and June 2011. We explored the law of OLM according to the distribution of occult nodes. Log-rank method and Cox proportional hazard regression model were used to analyze the prognosis of patients with or without OLM and Kaplan-Meier method was used to describe their survival curves. Univariate statistical analysis（χ2method） was performed to analyze the factors predicting OLM, multivariate logistical regression analysis was then undertaken.Results There were 46 patients with OLM in 232 cases with c T1-2N0M0 OSCC. OLM was found mainly in level Ⅱ（42.9%）, secondly in level Ⅰ（31.7%）, thirdly in level Ⅲ（19.0%）. Cox multivariate analysis identified OLM as the only independent predictive factor of survival. Its 5-year overall survival（OS）, disease-specific survival（DSS） and recurrence-free survival（RFS） rates were 63.0%, 73.9% and56.5%, which were significantly lower than patients without OLM（χ2OS= 45.0, χ2DSS= 31.2, χ2RFS= 58.6,P-values were all 〈0.05）. Univariate analysis showed that the degree of invasion, occurrence time and tumor growth pattern were the significant factors of OLM. Multivariate logistic regression analysis showed that the degree of invasion（Wald = 13.0, P = 0.001） and occurrence time（Wald = 7.9, P = 0.049） were the close related factors of OLM. Among these factors, muscular invasion and over one year occurrence time were the predictive factors of OLM, their OR value were 6.0 and 4.6, respectively. Conclusion The OLM of c T1-2N0M0 OSCC mainly distribute in level Ⅰ, Ⅱ and Ⅲ. For clinical T1-2N0M0 OSCC patients, elective neck dissection might be taken into consideration when the tumor lasts for more than6 months or invades muscular layer, which are easily lead to OLM.