Analysis and management of occult cervical lymph node metastasis of cN0 supraglottic laryngeal carcinoma
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摘要: 目的 探讨cN0声门上型喉癌颈部淋巴结隐匿性转移的规律及处理。方法 回顾性分析185例cN0声门上型喉癌患者的临床资料，患者行喉部手术的同时行颈侧清扫术。生存曲线绘制采用Kaplan-Meier法，生存率的比较采用卡方检验、log rank检验。结果 颈清扫术后淋巴结阳性(pN+)72例，颈淋巴结隐匿性转移率为38.9%(72/185)，其中单侧为27.6%(51/185)，双侧为11.4%(21/185)。共获病理阳性淋巴结266枚，位于Ⅱ区220枚(82.7%)，Ⅲ区42枚(15.8%)，Ⅳ区4枚(1.5%)。不同分化程度鳞状细胞癌的双侧颈淋巴隐匿性转移率分别为低分化鳞状细胞癌37.5%(12/32)，中分化鳞状细胞癌7.4%(6/81)，高分化鳞状细胞癌4.2%(3/72)；不同肿瘤T分期的双侧颈淋巴结隐匿性转移率分别为T1 0，T2 2.7%(2/73)，T3 8.1%(6/74)，T4 46.4%(13/28)，差异均有统计学意义(P < 0.01)。结论 cN0声门上型喉癌有较高的颈淋巴结隐匿性转移率，转移区域主要位于Ⅱ~Ⅲ区，处理原发灶的同时应行Ⅱ~Ⅲ区颈侧清扫术。对于低分化鳞状细胞癌、T4期的cN0声门上型喉癌患者，应行双侧颈侧清扫术。Abstract: Objective To explore the rule of occult cervical lymph nodes metastasis in clinically node negative(cN0) supraglottic laryngeal carcinoma.Method The clinical data of 185 patients with cN0 supraglottic laryngeal carcinoma were analyzed retrospectively. All patients received surgical resection of the primary lesions and lateral neck dissection. The survival curve was analyzed by Kaplan-Meier method, and the survival rate was compared by chi-square test and log rank test.Result The total incidence of occult cervical lymph nodes metastasis in cN0 supraglottic laryngeal carcinoma was 38.9%(72/185), the unilateral and bilateral neck occult metastases were determined in 51 cases(27.6%) and 21 cases(11.4%) respectively. A total of 266 positive nodes were collected, and the distributions of the 266 positive nodes were as follows: 220(82.7%) in level Ⅱ, 42(15.8%) in level Ⅲ, and 4(1.5%) in level Ⅳ. The occult metastasis rates of bilateral cervical lymph nodes with different degrees of differentiation were 37.5%(12/32) for poorly differentiated squamous cell carcinoma, 7.4%(6/81) for moderately differentiated squamous cell carcinoma, and 4.2%(3/72) for high differentiated squamous cell carcinoma; the occult metastasis rates of bilateral cervical lymph nodes at T1, T2, T3, T4 were 0, 2.7%(2/73), 8.1%(6/74), 46.4%(13/28), respectively, and the difference was statistically significant(P < 0.01).Conclusion cN0 supraglottic laryngeal carcinoma has a high rate of occult cervical lymph nodes metastasis, and its metastatic area is mainly located in level Ⅱ-Ⅲ, so the primary tumor of the laryngeal carcinoma and the neck lymph node of level Ⅱ-Ⅲ should be managed at the same time. For the cN0 patients with poorly differentiated squamous cell carcinoma or T4 staging should be treated with bilateral neck dissection.
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Key words:
- laryngeal neoplasms /
- occult lymph node metastasis /
- neck dissection /
- prognosis
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