头颈部鳞状细胞癌远处转移的相关因素分析

Analysis of risk factors in the prediction of distant metastases of head and neck squamous cell carcinomas

目的 探讨头颈肿瘤远处转移的相关影响因素。方法 对 5 32例头颈部原发鳞状细胞癌患者的临床病理资料进行回顾性分析。选择性别、年龄、临床分期、T分级、N分级、原发癌部位、原发癌浸润深度、原发癌病理分级、有无颈淋巴结转移、颈阳性淋巴结数目、颈淋巴结转移累及区域、颈阳性淋巴结破膜情况等临床病理因素 ,用 χ2 检验和Logistic回归进行单因素和多因素分析 ,并用Kaplan Meier法对发生远隔部位转移患者进行生存分析。结果 在 5 32例头颈部原发鳞状细胞癌患者中 ,6 0例 (11 3% )发生远处转移。单因素分析显示 ,临床分期 (P =0 0 12 6 )、T分级 (P =0 0 0 82 )、原发癌部位 (P =0 0 0 11)、原发癌浸润深度 (P =0 0 0 0 5 )、有无颈淋巴结转移 (P =0 0 0 5 7)、颈阳性淋巴结数目 (P =0 0 14 9)、颈淋巴结转移累及区域 (P =0 0 0 34)、颈阳性淋巴结破膜情况 (P =0 0 118)与发生远处转移有关。多因素分析结果表明 ,仅原发癌部位、原发癌浸润深度与发生远处转移明显相关。用Kaplan Meier法进行生存分析 ,结果显示 6 0例发生远隔部位转移患者的 1年生存率、3年生存率、5年生存率分别为 5 1 7%、13 3%、6 5 %。结论 原发肿瘤部位和浸润深度是发生远处转移的共同决定性因素。而原发癌临床分期?

Objective To investigate the risk factors related with distant metastases (DM) from head and neck squamous cell carcinomas (HNSCC) Methods A retrospective study was carried out to review the histopathological data from 532 HNSCC patients treated in Bethune International Peace Hospital from February 1978 to February 1998 The incidence and the risk factor for DM were evaluated in a model that included the following factors: sex, age, clinical staging, T and N staging, site of primary tumor, depth of primary tumor infiltration, histological grade of primary tumor, presence of cervical lymph node metastasis, number of positive neck nodes and levels involved, and presence of extracapsular nodal spread Univariate χ 2 test and multivariate stepwise logistic regression model were used for the analysis Statistical analysis of overall survival was performed using Kaplan Meier method Results Sixty cases (11 3%) presented distant metastases in 532 patients of head and neck squamous cell carcinomas In a univariate analysis, it was confirmed that the following variables correlated to DM, i e , clinical staging( P =0 0126), T classification( P =0 0082), site of primary tumor( P =0 0011), depth of primary tumor infiltration( P =0 0005), presence of cervical metastasis( P =0 0057), number of positive neck nodes( P =0 0149) and levels involved( P =0 0034), presence of extracapsular nodal spread( P =0 0118) In a multivariate analysis, the most significant risk factors for DM were the site of primary tumor and the depth of primary tumor infiltration Kaplan Meier analysis showed that overall survival rates of 60 HNSCC patients who presented distant metastases were 51 7% at 1 year, 13 3% at 3 years, 6 5% at 5 years, respectively Conclusion The site of primary tumor and the depth of primary tumor infiltration are the key risk factors in determining the development of DM in HNSCC patients Patients with laryngeal and hypopharyngeal carcinomas and patients with primary tumor infiltrating muscular, bone or cartilage level have the highest risk of developing DM