区域性颈清扫术对cN0喉癌术后病理颈淋巴结阳性的疗效分析

The effect of regional neck dissection on positive cervical lymph node of cN0 laryngeal carcinoma

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.