摘要
目的:探讨区域性颈清扫术治疗cN0喉癌术后病理颈淋巴结阳性的安全性及有效性。方法:回顾性分析2000-01-2016-06在我科首次行原发灶切除+区域性颈清扫术(Ⅱ~Ⅳ区)的120例cN0喉鳞状细胞癌患者的临床资料,筛选出术后石蜡病理示颈部Ⅱ~Ⅳ区淋巴结阳性的患者(pN+)共22例,随访截止2017年6月。对cN0pN+喉癌患者术后的复发率和生存率作生存相关回归分析。结果:区域性颈清扫术后cN0喉癌的隐匿性转移率为18.33%(22/120)。cN0pN+患者术后3年局部复发率、颈部复发率、远处转移率分别为41.18%、17.65%、17.65%;术后5年分别为40.00%、13.33%、20.00%。采用Kaplan-Meier法计算术后3、5年总体生存率分别为61.2%和30.6%,无瘤生存率分别为31.8%和22.7%。采用Log-Rank检验各T分期与临床分型之间的总体生存率、无瘤生存率差异均无统计学意义(均P>0.05)。Cox回归分析总体生存率与年龄、局部颈部复发情况差异有统计学意义(RR=11.421,P=0.001;RR=5.211,P=0.022)。Logistic多因素回归分析,颈部局部复发与各因素之间差异无统计学意义(P>0.05)。结论:cN0pN+喉癌患者虽然局部复发率、死亡率较高,生存率较低,但颈部复发率较低,因此,Ⅱ~Ⅳ区域性颈清扫术对cN0pN+喉癌的颈部处理是一种安全有效的治疗方案。
Objective:To evaluate the efficacy and safety of regional neck dissection in the treatment of cN0 laryngeal carcinoma with positive cervical lymph node.Method:A retrospective analysis of 120 cases with cN0 laryngeal squamous cell carcinoma who received the first time for primary tumor resection and regional neck dissection(Ⅱ-Ⅳ)in our hospital during the period of 2000.01-2016.06 were performed.Twenty-two patients with lymph node positive(pN+)were selected by postoperative paraffin pathology inⅡ-Ⅳregion and followed up to2017.06.The recurrence rate,survival rate and survival related regression analysis of patients with stage cN0 pN+ laryngeal carcinoma were analyzed.Result:The cN0 laryngeal cancer occult metastasis rate was 18.33%(22/120)in regional neck dissection.Local recurrence,regional recurrence,distant metastasis rates of 3 and 5 years were 41.18%,17.65%,17.65%and 40.00%,13.33%,20.00%,respectively in cN0 pN+ patients.The overall survival rates of 3 and 5 years were 61.2% and 30.6% respectively,and the disease-free survival rate was31.8% and 22.7%.There was no significant difference in overall and disease-free survival between the T staging or clinical classification(P〉0.05).Cox regression analysis showed that overall survival was related to age and local-regional(RR=11.421,P=0.001,RR=5.211,P=0.022).Logistic multivariate regression analysis showed that local-regional recurrence was not related to each factor(P〉0.05).Conclusion:Local recurrence rate and mortality rate of cN0 pN+ laryngeal carcinoma are higher,survival rate is lower,however,neck recurrence rate is low.Therefore,Ⅱ-Ⅳneck dissection is a safe and effective treatment for neck of cN0 pN+laryngeal carcinoma.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2017年第23期1793-1796,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
根治性颈清扫术
淋巴结
转移
喉肿瘤
生存分析
radical neck dissection
lymph node
metastasis
laryngeal neoplasms
survival analysis