下咽癌颈部淋巴结密度值对预后的影响

The effect of cervical lymph node metastasis density on prognosis of hypopharyngeal carcinoma

目的研究下咽癌颈部淋巴结密度值(lymph node density,LND)与预后的关系。方法回顾性分析2014年1月至2017年12月山东省耳鼻喉医院收治行手术治疗的241例下咽癌患者的临床病理资料,其中男性229例,女性12例,年龄37~81岁。计算患者的颈部LND,即转移淋巴结数量与清扫的淋巴结总数的比值。应用受试者工作特征(ROC)曲线确定LND的最佳截断值,将患者分为低LND组和高LND组。对患者进行无病生存期(disease-free survival,DFS)和总生存期(overall survival,OS)的单因素和多因素分析。结果截断值为0.068,低LND组(<0.068)患者165例,高LND组(≥0.068)患者76例。LND大小与T分期、N分期、最大淋巴结直径、淋巴结包膜外侵犯、咽后淋巴结转移有关(统计值分别为-3.15、-6.82、23.37、20.44、30.18,P值均<0.05)。单因素分析显示,年龄、T分期、N分期、颈部淋巴结最大直径、包膜外侵犯、咽后淋巴结转移以及LND是影响患者DFS(χ^(2)值分别为9.31、7.30、20.09、15.30、9.04、19.44、50.27,P值均<0.05)和OS(χ^(2)值分别为5.02、12.94、18.28、15.91、7.95、16.88、49.45,P值均<0.05)的因素。多因素分析显示:年龄≤60岁、LND≥0.068的患者DFS更短(HR值分别为0.61、2.23,95%CI分别为0.43~0.88、1.44~3.45,P值均<0.05);T分期晚、LND≥0.068的患者OS更短(HR值分别为1.73、2.39,95%CI分别为1.02~2.93、1.51~3.80,P值均<0.05)。结论LND是下咽癌术后患者预后的影响因素,LND≥0.068的患者预后差。

Objective To investigate the relationship between the cervical lymph node density(LND)and the prognosis of hypopharyngeal carcinoma.Methods The clinical and pathological data of 241 patients with hypopharyngeal carcinoma who underwent surgery in Shandong Provincial ENT Hospital from January 2014 to December 2017 were retrospectively analyzed,including 229 males and 12 females,aged 37-81 years.The LND was calculated,i.e.the ratio of the number of lymph nodes with metastasis to the total number of lymph nodes removed.The patients were divided into low LND group and high LND group based on the cutoff value of LND determined by receiver operating characteristic curve(ROC curve).The univariate and multivariate analyses of the disease-free survival(DFS)and the overall survival(OS)were performed in two groups.Results With the cutoff value of 0.068,165 patients were in the low LND group(<0.068)and 76 patients in the high LND group(≥0.068).T stage,N stage,maximum lymph node diameter,extracellular invasion of lymph node,and postpharyngeal lymph node metastasis were associated with LND(statistical values were-3.15,-6.82,23.37,20.44,and 30.18,respectively,all P values were<0.05).The univariate analysis showed that age,T stage,N stage,maximum diameter of cervical lymph nodes,extracapsular invasion,retropharyngeal lymph node metastasis and LND were the main factors affecting the patients′DFS(χ^(2)=9.31,7.30,20.09,15.30,9.04,19.44,50.27,all P values<0.05)and OS(χ^(2) were 5.02,12.94,18.28,15.91,7.95,16.88,49.45,all P values<0.05).Multivariate analysis showed that patients with age≤60 years old and LND≥0.068 had reduced DFS[HR values were 0.61(95%CI 0.43-0.88)and 2.23(95%CI 1.44-3.45),both P values<0.05];patients with advanced T stage and LND≥0.068 had reduced OS[HR values were 1.73(95%CI 1.02-2.93)and 2.39(95%CI 1.51-3.80),both P values<0.05].Conclusion LND is a prognostic factor for patients with hypopharyngeal carcinoma after surgery,with worse prognosis in patients with LND≥0.068.