cN0上颌恶性肿瘤颈淋巴结转移的临床分析

Clinical analysis of cervical lymph node metastasis of cN0 maxillary malignant tumor

目的:探讨和比较不同病理类型临床颈淋巴结阴性(clinically negative neck lymph node,c N0)上颌恶性肿瘤的颈淋巴结转移率,为此类患者颈部淋巴结的处理提供参考。方法:选择1990年至2010年就诊于北京大学口腔医院具有完整临床及随访资料的c N0上颌恶性肿瘤患者277例,记录颈淋巴结转移情况及相关临床信息,研究不同病理类型上颌恶性肿瘤颈淋巴结转移的发生规律,并通过SPSS 19.0统计学软件分析影响上颈恶性肿瘤淋巴结转移的相关因素。结果:277例c N0上颌恶性肿瘤患者的总体颈淋巴结转移发生率为15.5%(43/277),上颌鳞状细胞癌因其较强的淋巴结转移倾向,颈淋巴结转移率为33.0%;腺源性癌的整体转移率较低,为7.6%,且发生颈淋巴结转移的时间较晚,但高度恶性腺源性癌的淋巴结转移率明显高于中、低度恶性腺源性癌(分别为P=0.037),其中非特异性腺癌、低分化黏液表皮样癌、导管癌的颈淋巴结转移率高于15%,而同属于高度恶性肿瘤的腺样囊性癌与肌上皮癌的转移率较低;肉瘤类恶性肿瘤的整体淋巴结转移率很低,仅为4.9%。结论:建议对c N0上颌鳞状细胞癌患者行选择性颈淋巴结清扫术,对于非特异性腺癌、低分化黏液表皮样癌、导管癌等高度恶性腺源性癌患者可行选择性颈淋巴结清扫术,对于肉瘤类患者可对颈部进行密切观察。

Objective： To investigate the cervical lymphatic metastasis rates of clinically negative neck lymph node（ c N0） maxillary malignant tumors,to compare the cervical lymphatic metastasis rates of the various pathological types,and to provide the reference for the treatment of the neck of the patients with c N0 maxillary malignant tumor. Methods： The clinical data of 277 cases with c N0 maxillary malignant tumor,treated in the department of oral and maxillofacial surgery of Peking University School and Hospital of Stomatology from 1990 to 2010,were reviewed. The cervical lymph node metastasis and the related clinical information were recorded. The clinical information including histopathology type of the tumors,tumor grade,primary site and TNM staging,as well as other demographic and clinical data,were retrieved from the electronic medical record system（ EMRS） of the hospital. The pathogenesis of cervical lymph node metastasis in maxillary malignant tumors of different histopathological types,and the factors related to lymph node metastasis of upper cervical malignancy were analyzed by SPSS 19. 0 statistical software. Results： The overall cervical lymph node metastasis rate of the 277 patients with c N0 maxillary malignant tumor was 15. 5%（ 43/277）. Maxillary squamous cell carcinoma（ SCC） had a strong cervical lymph node metastasis tendency and the rate was 33. 0%. The overall metastatic rate of adenocarcinoma was 7. 6% lower than that of SCC,and the occurrence of cervical lymph node metastasis time was relatively late,but the metastasis rate of highly malignant grade salivary gland carcinoma was significantly higher than that of intermediate and low grade carcinoma（ P = 0. 037）. The metastatic rates of some highly malignant c N0 salivary gland carcinomas including adenocarcinoma,not other specified,highgrade mucoepidermoid carcinoma（ MEC）,and salivary duct carcinoma were exceeded 15%,while the metastasis rates of adenoid cystic carcinoma and myoepithelial carcinoma were lower. The metastasis rate of the sarcomas was very low with the rate of 4. 9%. Conclusion： Selective neck dissection（ SND） is recommended for c N0 maxillary SCC and feasible for some highly malignant c N0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade MEC,salivary duct carcinoma. The neck can be closely observed for the patients with maxillary sarcoma.