早期舌鳞状细胞癌颈淋巴结转移规律、手术方式选择及预后相关因素分析

Neck lymphatic metastasis, surgical methods and prognosis in early tongue squamous cell carcinoma

目的研究早期舌鳞状细胞癌颈部淋巴结转移规律、手术方式的选择及预后，为临床提供参考。方法回顾性分析自2001年1月至2015年12月潍坊市人民医院收治的157例早期舌鳞状细胞癌患者的病例资料，分析其颈部淋巴结转移规律，确定最佳手术方式及对影响预后的因素进行分析。结果颈淋巴结转移的发生率为31%（48/157），颈淋巴结转移患者与无转移患者的肿瘤大小（P=0.026）、组织分化类型（P=0.022）差异均有统计学意义。颈淋巴结转移最常见的是Ⅱ区[33%（16/48）]，Ⅳ区出现淋巴结转移的发生率为5%（7/157），未见跳跃性转移，校正χ^2检验示当颈部Ⅱ区或Ⅲ区出现淋巴结转移时，颈部Ⅳ区更易出现转移（P=0.000，P=0.000）。单因素分析示早期舌鳞状细胞癌患者肿瘤的组织分化类型、肿瘤复发、颈部淋巴结转移及术后放疗是影响患者预后的因素（P〈0.05）。结论早期舌鳞状细胞癌的颈部淋巴结转移发生率较高，需同期行颈淋巴结清扫术；颈部Ⅳ区的淋巴结转移发生率较低，仅行肩胛舌骨肌上颈淋巴结清扫术即可。

Objective To investigate the different pattern of neck lymph node metastasis, the choice of surgical methods and prognosis in early tongue squamous cell carcinoma.Methods A total of 157 patients with early oral tongue squamous cell carcinoma were included in this study. Statistical analysis was performed to identify the pattern of lymph node metastasis, to determine the best surgical procedure and to analyze the prognosis.Results The occurrence of cervical lymph node metastasis rate was 31%（48/157）. Neck lymphatic metastasis was significantly related to tumor size （P=0.026） and histology differentiation type （P=0.022）. The rate of metastasis was highest in level Ⅱ [33% （16/48）]. In level Ⅳ, the incidence of lymph node metastasis was 5%（7/157）, and there was no skip metastases. The possibility of level Ⅳ metastasis was higher, when level Ⅱ （P=0.000） or Ⅲ （P=0.000） involved. The differentiation tumor recurrence, neck lymphatic metastasis and adjuvant radiotherapy were prognostic factors （P〈0.05）. Multivariate analyses revealed histology differentiation type, neck lymphatic metastases and adjuvant radiotherapy were the independent prognostic factors.Conclusions Neck lymphatic metastasis rate is high in early tongue squamous cell carcinoma, simultaneous glossectomy and neck dissection should be performed. Level Ⅳ metastasis rate is extremely low, so supraomohyoid neck dissection is sufficient for most of the time. The histology differentiation type, neck lymphatic metastasis and adjuvant radiotherapy are independent prognostic factors.