高级搜索

临床N0期舌癌颈淋巴结转移相关因素及其外科处理

田 鑫, 莫立根, 罗 莹

田 鑫, 莫立根, 罗 莹. 临床N0期舌癌颈淋巴结转移相关因素及其外科处理[J]. 肿瘤防治研究, 2014, 41(07): 751-755. DOI: 10.3971/j.issn.1000-8578.2014.07.014
引用本文: 田 鑫, 莫立根, 罗 莹. 临床N0期舌癌颈淋巴结转移相关因素及其外科处理[J]. 肿瘤防治研究, 2014, 41(07): 751-755. DOI: 10.3971/j.issn.1000-8578.2014.07.014
TIAN Xin, MO Ligen, LUO Ying. Relative Factors and Surgical Treatment of Neck Lymph Node Metastasis of cN0 Tongue Cancer[J]. Cancer Research on Prevention and Treatment, 2014, 41(07): 751-755. DOI: 10.3971/j.issn.1000-8578.2014.07.014
Citation: TIAN Xin, MO Ligen, LUO Ying. Relative Factors and Surgical Treatment of Neck Lymph Node Metastasis of cN0 Tongue Cancer[J]. Cancer Research on Prevention and Treatment, 2014, 41(07): 751-755. DOI: 10.3971/j.issn.1000-8578.2014.07.014

临床N0期舌癌颈淋巴结转移相关因素及其外科处理

详细信息
    作者简介:

    田鑫(1981-),男,硕士,主治医师,主要从事头颈肿瘤的基础与临床研究

    通讯作者:

    莫立根,E-mail:ligenmo@163.com

  • 中图分类号: R739.86

Relative Factors and Surgical Treatment of Neck Lymph Node Metastasis of cN0 Tongue Cancer

  • 摘要: 目的 探讨舌癌隐匿性颈淋巴结转移规律和相关影响因素,以及不同颈淋巴清扫术式对舌癌的预后影响,为cN0期舌癌患者颈淋巴清扫术术式的选择提供理论依据。方法 收集2002年1月至2010 年8月在广西医科大学附属肿瘤医院头颈外科初治的cN0期舌癌住院患者87例。通过单因素分析隐匿性颈淋巴结转移与年龄、性别、术前疾病持续时间、原发灶浸润深度、T分期、病理分级的相关性,多因素分析cN0期舌癌患者的预后影响因素,探讨舌鳞癌颈部转移规律及外科处理方式。结果 单因素统计分析显示:性别、年龄、术前疾病持续时间对cN0期舌癌患者隐匿性颈淋巴结转移的影响差异无统计学意义(P>0.05),而原发灶浸润深度、T分期、病理分级等因素对颈淋巴结转移的影响差异有统计学意义(P<0.05)。多因素Cox风险比例模型分析显示:只有T分期是舌癌cN0期患者的独立预后因素,不同颈淋巴清扫术对其预后的影响差异无统计学意义。颈择区性淋巴清扫术对肩部的影响更小(P<0.05)。结论 原发灶浸润深度、T分期、病理分级与cN0期舌癌隐匿性颈淋巴结转移有关,可以作为预测cN0期舌癌隐匿性颈淋巴结转移的指标;cN0期舌癌具有较高的隐匿性颈部淋巴结转移率,以同侧颈部Ⅰ、Ⅱ、Ⅲ区最为常见,主张行颈择区淋巴清扫术。

     

    Abstract: Objective To investigate the rules and related factors of occult neck lymphatic metastasis of tongue cancer, and the influence of different neck dissections on the prognosis to provide evidence for choosing suitable operation methods. Methods The data of 87 cN0 tongue cancer patients who had been diagnosed as squamous cell carcinoma were collected in Head and Neck Surgical Department, Guangxi Medical University Affiliated Tumor Hospital from January 1, 2002 to August 31, 2009. They didn't receive radiation or chemotherapy before surgery. Univariate analysis was applied to analyze the correlation between occult cervical lymph node metastasis and age, gender, preoperative disease duration, depth of primary tumor invasion, T stage, histological grading. Multivariate analysis was used to analyze prognostic factors for cN0 tongue cancer patients, distribution rules of occult cervical lymph node metastasis, and different methods of neck dissection. Results Univariate analysis showed that the difference was not statistically significant in the effect of sex, age or preoperative disease duration(P>0.05) whereas significant in the effect of primary tumor invasion depth, T stage and histological grade(P<0.05) on patients with occult cervical lymph node metastasis from cN0 tongue cancer. Multivariate analysis showed that only T stage was the independent factor for the prognosis of cN0 tongue cancer patients. The factors of different neck dissections had no significant difference(P<0.05). Conclusion Invasion depth of primary tumor, T stage and histological grading are closely related to cN0 tongue cancer patients with occult lymphatic metastasis, therefore,they could be the predicted indexes; cN0 tongue cancer has a high rate of occult lymph node metastasis. The most common metastasizing area are levelⅠ,Ⅱand Ⅲ of the Ipsilateral neck; we recommend the selective neck dissection under that circumstances.

     

  • [1] Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer[J]. Oral Oncol, 2009, 45(4-5): 309-16.
    [2] Lenz M,Kersting-Sommerhoff B,Gross M.Diagnosis and treatment of the N0 neck in carcinomas of the upper aerodigestive tract: current status of diagnostic procedures[J]. Eur Arch Otorhin olaryngol,1993,250(8): 432-8.
    [3] Jones AS,Roland NJ, Field JK,et al.The level of cervical lymph node metastases: their prognostic relevance and relationship with head and neck squamous carcinoma primary sites[J].Clin Otolaryngol Allied Sci,1994,19(1):63-9.
    [4] Gonzalez-Moles MA,Esteban F,Rodriquez-Archilla A,et al. Importance of tumour thickness measurement in prognosis of tongue cancer[J]. Oral Oncol, 2002, 38(4): 394-7.
    [5] Lee JG, Litton WB. Occult regional metastasis: carcinoma of the oral tongue[J]. Laryngoscope,1972,82(7):1273-81.
    [6] Iype EM, Sebastian P, Mathew A, et al. The role of selective neck dissection (I-III) in the treatment of node negative (N0) neck in oral cancer[J]. Oral Oncol, 2008, 44(12):1134-8.
    [7] Kligerman J, Lima RA, Soares JR, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity[J]. Am J Surg, 1994, 168(5):391-4.
    [8] O-charoenrat P, Pillai G, Patel S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer[J]. Oral Oncol, 2003, 39(4): 386-90.
    [9] Fukano H, Matsuura H, Hasegawa Y, et al. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma[J]. Head Neck, 1997,19(3):205-10.
    [10] Hayashi T, Ito J, Taira S, et al. The relationship of primary tumor thickness in carcinoma of the tongue to subsequent lymph node metastasis[J]. Dentomaxillofac Radiol, 2001, 30(5): 242-5.
    [11] Larsen SR, Johansen J,S?rensen JA, et al. The prognostic significance of histological features in oral squamous cell carcinoma[J]. J Oral Pathol Med, 2009, 38(8):657-62.
    [12] Luan XW, Li XN, Mao C. Clinical study on occult cervical lymph node metastases in patients with oral squamous cell carcinoma[J]. Guangdong Ya Bing Fang Zhi, 2007, 15(6):251-3. [栾修文,李晓 娜,毛驰. cN0口腔鳞癌颈部淋巴结转移的术后回顾性分析[J]. 广东牙病防治, 2007, 15(6):251-3.]
    [13] Woolgar JA. Pathology of the N0 neck[J]. Br J Oral Maxillofac Surg, 1999,37(3): 205-9.
    [14] Kang FW, Wu ZH, Huang X, et al.Treatment to cN0 patients with oral squamous cell carcinoma[J]. Huaxi Kou Qiang Yi Xue Za Zhi, 2003,21(4):298-300. [康非吾,吴正华,黄欣,等.口 腔鳞癌患者颈淋巴结cN0的处理[ J ] . 华西口腔医学杂志, 20 03,21(4):298-300.]
    [15] Wagner JD,Davidson D,Coleman JJ 3rd,et al. Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma[J]. Ann Surg Oncol, 1999, 6(4): 398-404.
    [16] Guo ZM, Zhang Q, Zeng ZY, et al. Regularity and therapeutic strategy of cervical lymph node metastasis in squamous cell carcinoma of the tongue[J]. Ai Zheng, 2003,22(3):282-5. [郭朱明, 张诠,曾宗渊,等.舌体鳞癌颈淋巴结转移的规律和治疗策略[J]. 癌症, 2003,22(3):282-5.]
    [17] Jin WL, Ye WM, Zheng JW, et al.Occult cervical lymph node metastases in 100 consecutive patients with cN0 tongue cancer[J]. Chin Med J(Engl),2008, 121(19):1871-4.
    [18] Shores CG, Yin X, Funkhouser W, et al.Clinical evaluation of a new molecular method for detection of micrometastases in head and neck squamous cell carcinoma[J]. Arch Otolaryngol Head Neck Surg, 2004, 130(8):937-42.
    [19] Eufinger HJ, Lehmbrock J.Life threatening and fatal complications of radical neck dissection[J]. Mund Kiefer Gesichtschir, 20 01,5(3):193-7.
    [20] Zhong WS, Zhang Q, Guo ZM, et al. rognostic factors of early tongue squamous cell carcinoma and neck treatment[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi,2010, 45(12):1020-4. [钟 外生,张诠,郭朱明,等.影响早期舌癌预后的因素及颈部的治疗 [J] 中华耳鼻咽喉头颈外科杂志, 2010,45(12):1020-4.]
计量
  • 文章访问数:  1494
  • HTML全文浏览量:  349
  • PDF下载量:  842
  • 被引次数: 0
出版历程
  • 刊出日期:  2014-07-24

目录

    /

    返回文章
    返回
    x 关闭 永久关闭