舌鳞癌隐匿性颈淋巴结转移与临床病理相关因素的关系

Clinical and Pathological Related F actors of Occult Cervical Lymph Node Metastasis in Squamous Cell Car cinoma of Tongue

背景与目的:舌鳞癌的某些临床、组织病理学特征与隐匿性颈淋巴结转移密切相关。本研究旨在探讨舌鳞癌隐匿性颈淋巴结转移与原发灶临床和病理的相关性。方法:选择1988～1996年间在我院治疗、有隐匿性颈淋巴结转移的舌鳞癌患者35例;另选择同期无颈淋巴结转移的舌鳞癌患者35例,在显微镜下测量肿瘤浸润深度、评定组织病理学参数。结果:70例cN0舌鳞癌中,大体形态为浸润加溃疡型、浸润型、溃疡型和外生型4组的隐匿性颈淋巴结转移率分别为70.37%、41.67%、40.00%和27.27%;T1、T2和T43组分别为44.00%、43.48%和62.64%;肿瘤浸润深度<4mm、4～7.9mm和≥8mm3组的隐匿性颈淋巴结转移率分别为14.29%、61.54%和88.89%;癌周淋巴细胞反应“+”、“++”和“+++”3组分别为73.68%、58.62%和18.18%;脉管侵犯和无脉管侵犯两组分别为85.71%和46.03%;病理为高、中和低分化3组分别为52.63%、42.31%和66.67%;浸润方式为Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型4组分别为40.9%、50.0%、52.0%和80.0%。单因素分析显示原发肿瘤的大体形态、肿瘤浸润深度、癌周淋巴细胞反应程度和脉管侵犯等参数与舌鳞癌隐匿性颈淋巴结转移的相关性有统计学意义(P<0.05),而T分期、病理分化程度和浸润方式等参数与隐匿性颈淋巴结转移的相关性无统计学意义(P>0.05);

BACKGROUND &OBJECTIVE:Some clinical and histopatho-log ical features of squamous cell ca rcinoma of tong ue(TSCC)were closely associated with occult cervical lym ph node metastasis(OCLNM).This study was desig ned to investig ate the correla tion between occult cervical lymph n ode metastasis in squamous cell carcino ma of tong ue and the clinicopatholog ical indexes of primary tumor tissue.METHODS :Thirty-five TSCC patients with OCLNM treated in Cancer Center,Sun Y at-sen University from 1988to 1996were enrolled.According to random p rinciple,35TSCC patients without O CLNM at the same period were selected.Tum or deepness was measured and patholog ical parameters were asses sed under microscope.RESULTS:The rates of OCLNM in g roup of infiltrative plu s ulcerative type,g roup of infiltra tive type,g roup of ulcerative type and g roup of exog enous type were 70.37%,41.67%,40.00%,and 27.27%,respectively;t he rates of OCLNM in T1,T2,and T4were 44.00%,43.48%,and 62.64%,res pectively.The rates of OCLNM in g roups of tumor deepness <4mm,4-7.9mm,and≥8mm were 14.29%,61.54%,and 88.89%,respectively.T he rates of OCLNM in g roups of respons e of peritumoral lymphocyte +,++and +++were 73.68%,58.62%,and18.18%,respectively.The rates of O CLNM in g roups of with vascular invas ion and without vascular invasion were 85.71%and 46.03%,respectively.The rates of OCLNM in g roups of well,mode rate,and poor differentiation were52.63%,42.31%,and 66.67%,respect ively.The rates of OCLNM in g roups of invasive patterns of type Ⅰ,type Ⅱ,type Ⅲ,and type Ⅳwere 40.90%,50.00%,52.00%,and 80.00%,respect ively.Univariate analysis indicat ed that OCLNM in TSCC was closely associ ated with g ross appearance of primar y tumor,tumor deepness ,response deg ree of peritumoral lymphocyte and vascular invasion(P<0.05),but was not associated with T stag e,patholog ical differentiation,and invasion way(P>0.05);Log istic multivariate analysis manifested that only tumor deepness and response deg ree of peritumoral lymphocyte sig nificantly correlat ed with OCLNM in TSCC.CONCLUSION:There was sig nificant correlation betwee n g ross appearance of primary tumor,tumor deepness ,response deg ree of peritu moral lymphocyte and vascular invas ion and OCLNM in TSCC.These parameters c an be used to predict occult cervical lymph node metastasis in TSCC.