区域性颈清扫术对cN0喉癌术后病理颈淋巴结阳性的疗效分析

李晓雨; 李进让; 郭红光

doi:10.13201/j.issn.1001-1781.2017.23.003

区域性颈清扫术对cN0喉癌术后病理颈淋巴结阳性的疗效分析

- 海军总医院全军耳鼻咽喉头颈外科中心(北京, 100048)

详细信息

通讯作者: 李进让, E-mail:entljr@sina.com

中图分类号: R739.65

收稿日期: 2017-07-26

The effect of regional neck dissection on positive cervical lymph node of cN0 laryngeal carcinoma

- Department of Otolaryngology Head and Neck Surgery, Navy General Hospital, Beijing, 100048, China

More Information

Corresponding author: LI Jinrang, E-mail: entljr@sina.com

Received Date: 26 July 2017

摘要

摘要: 目的: 探讨区域性颈清扫术治疗cN0喉癌术后病理颈淋巴结阳性的安全性及有效性。方法: 回顾性分析2000-01-2016-06在我科首次行原发灶切除+区域性颈清扫术(Ⅱ~Ⅳ区)的120例cN0喉鳞状细胞癌患者的临床资料,筛选出术后石蜡病理示颈部Ⅱ~Ⅳ区淋巴结阳性的患者(pN+)共22例,随访截止2017年6月。对cN0 pN+喉癌患者术后的复发率和生存率作生存相关回归分析。结果: 区域性颈清扫术后cN0喉癌的隐匿性转移率为18.33%(22/120)。cN0 pN+患者术后3年局部复发率、颈部复发率、远处转移率分别为41.18%、17.65%、17.65%;术后5年分别为40.00%、13.33%、20.00%。采用Kaplan-Meier法计算术后3、5年总体生存率分别为61.2%和30.6%,无瘤生存率分别为31.8%和22.7%。采用Log-Rank检验各T分期与临床分型之间的总体生存率、无瘤生存率差异均无统计学意义(均P>0.05)。Cox回归分析总体生存率与年龄、局部颈部复发情况差异有统计学意义(RR=11.421,P=0.001;RR=5.211,P=0.022)。Logistic多因素回归分析,颈部局部复发与各因素之间差异无统计学意义(P>0.05)。结论: cN0 pN+喉癌患者虽然局部复发率、死亡率较高,生存率较低,但颈部复发率较低,因此,Ⅱ~Ⅳ区域性颈清扫术对cN0 pN+喉癌的颈部处理是一种安全有效的治疗方案。
- 根治性颈清扫术 /
- 淋巴结 /
- 转移 /
- 喉肿瘤 /
- 生存分析
Abstract: Objective: To evaluate the efficacy and safety of regional neck dissection in the treatment of cN0 laryngeal carcinoma with positive cervical lymph node.Method: A retrospective analysis of 120 cases with cN0 laryngeal squamous cell carcinoma who received the first time for primary tumor resection and regional neck dissection (Ⅱ-Ⅳ) in our hospital during the period of 2000.01-2016.06 were performed. Twenty-two patients with lymph node positive (pN+) were selected by postoperative paraffin pathology in Ⅱ-Ⅳ region and followed up to 2017.06. The recurrence rate, survival rate and survival related regression analysis of patients with stage cN0 pN+ laryngeal carcinoma were analyzed.Result: The cN0 laryngeal cancer occult metastasis rate was 18.33% (22/120) in regional neck dissection. Local recurrence, regional recurrence, distant metastasis rates of 3 and 5 years were 41.18%, 17.65%, 17.65% and 40.00%, 13.33%, 20.00%, respectively in cN0 pN+ patients. The overall survival rates of 3 and 5 years were 61.2% and 30.6% respectively, and the disease-free survival rate was 31.8% and 22.7%. There was no significant difference in overall and disease-free survival between the T staging or clinical classification (P>0.05). Cox regression analysis showed that overall survival was related to age and local-regional (RR=11.421, P=0.001, RR=5.211, P=0.022). Logistic multivariate regression analysis showed that local-regional recurrence was not related to each factor (P>0.05).Conclusion: Local recurrence rate and mortality rate of cN0 pN+ laryngeal carcinoma are higher, survival rate is lower, however, neck recurrence rate is low.Therefore, Ⅱ-Ⅳneck dissection is a safe and effective treatment for neck of cN0 pN+ laryngeal carcinoma.
- radical neck dissection /
- lymph node /
- metastasis /
- laryngeal neoplasms /
- survival analysis

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