779例鼻咽癌颈部淋巴结转移规律分析  

The patterns of metastatic cervical nodes in 779 cases of nasopharyngeal carcinoma

作　　者：陈奇松[1] 林少俊[1] 潘建基[1] 张瑜[1] 林锦[1] 陈英[2] 宗井凤[1] 卢涛[2] 

机构地区：[1]福建医科大学教学医院(福建省肿瘤医院放疗科),福建福州350014 [2]福建医科大学教学医院(福建省肿瘤医院放诊科),福建福州350014

出　　处：《中国癌症杂志》2010年第1期50-54,共5页China Oncology

摘　　要：背景与目的:鼻咽癌颈部淋巴结转移不仅影响临床分期及治疗计划,也是影响预后的主要因素之一。本研究旨在探讨鼻咽癌颈淋巴结转移的规律,为临床治疗及研究提供依据。方法:779例经病理证实的首诊鼻咽癌患者,治疗前均行MRI规范扫描,并根据影像学颈部淋巴结分区标准(RTOG2006版N+为基础)确定淋巴结位置。MRI资料分析由放疗科与影像科医师共同完成。以卡方检验分析不同T分期各区淋巴结转移率的差别及淋巴结不同直径之间包膜受侵的差别,同时分析淋巴结在各区分布特点及跳跃性转移情况。结果:本组患者中有592例(76.0%)出现转移淋巴结,各区分布如下:Ⅰ区1例(0.2%),Ⅱa区384例(64.9%),Ⅱb区499例(84.3%),Ⅲ区184例(31.1%),Ⅳ区33例(5.6%),Ⅴa区67例(11.3%),Ⅴb区21例(3.5%),咽后597例(76.6%)。本组各区最多转移淋巴结共1479个,其中包膜外侵973个(65.79%),包膜外侵比例随淋巴结直径增大而增大(P=0.000)。各区淋巴结转移和T分期之间无明显相关性,跳跃性转移率为1.0%。结论:鼻咽癌Ⅱ区和咽后淋巴结转移率最高,均为前哨淋巴结。Ⅰ区转移率极低。淋巴结包膜外侵比例与最大径正相关。淋巴结很少跳跃性转移,T分期和各区淋巴结转移之间无相关性。Background and purpose：Cervical nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical staging, it is also one of the main factors influencing prognosis. So this study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which may provide a basis for clinical treatment and research. Methods：From Jun. 2005 to Sep. 2007, 779 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiation therapy at Fujian Provincial Cancer Hospital. Diagnostic radiologists and radiation oncologists together assessed the nodal distribution according to the guideline CT-based delineation of lymph node levels. Then, Chi-square test was used to analyze the correlation between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion. Results：Of 779 patients, 592（76.0%） had nodal involvement. The distribution was as follows： 1 in level Ⅰ, 384 in level Ⅱa, 499 in level Ⅱb, 184 in level Ⅲ, 33 in level Ⅳ, 67 in level Ⅴa, 21 in level Ⅴb, 597 in retropharynx. In these patients, a total of 1 479 postive nodes, including 973 （65.79%） extracapsular spread nodes, were detected. The rate of nodal extracapsular invasion was higher when the axial diameter increased. Leap metastasis rate was 1.0%. No significant correlation was found between T stage and nodal involvement. Conclusion：The level Ⅱ and retropharyngeal node were the most frequently involved regions, they had similar metastatic rate and were both the first echo node to metastases of nasopharyngeal carcinoma. Level Ⅰ metastasis was lower. The proportion of extracapsular spread of metastatic lymph nodes increased with axial diameter of lymph nodes-dependent. The cervical node involvement of nasopharyngeal carcinoma was spread orderly down the neck, and the incidence of skip metastasis is rare. The relationship between T stage and nodal involvement has no statistical sign

关 键 词：鼻咽癌 淋巴结 磁共振成像 

分 类 号：R739.63[医药卫生—肿瘤]