颈淋巴结转移对晚期喉鳞状细胞癌生存影响  

Survival Impact of Cervical Metastasis in Advanced Laryngeal Squamous Cell Carcinoma

作　　者：张欣睿[1] 刘学奎[1] 李铨[1] 刘志民[1] 郭朱明[1] 张诠[1] 杨安奎[1] 曾宗渊[1] 

机构地区：[1]华南肿瘤学国家重点实验室//中山大学肿瘤防治中心头颈科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2012年第3期412-416,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2011B031800221)

摘　　要：【目的】探索颈淋巴结转移对晚期喉鳞状细胞癌患者生存率的影响。【方法】对1990年1月-2005年12月在中山大学肿瘤防治中心住院治疗的312例晚期喉鳞状细胞癌患者资料进行回顾性分析。初诊时临床有颈淋巴结转移者(cN+)141(45.2%)例,临床无颈淋巴结转移者(cN0)171(54.8%)例。颈淋巴结转移与否及N分期对生存率影响采用Kaplan-Meier法和Log-rank检验。【结果】初诊时141例cN+患者与171例cN0患者5年生存率分别为33.7%和60.5%(P<0.001)。cN1～cN3期患者5年生存率分别为40.6%、33.6%、0%(P<0.001)。初诊时cN+患者占45.2%(141/312);经治疗后,141例初诊cN+患者病理颈淋巴结转移,30例(30/171,17.5%)cN0初诊患者病理颈淋巴结转移,最终54.8%(171/312)患者出现病理颈淋巴结转移。【结论】有颈淋巴结转移的晚期喉鳞状细胞癌患者预后差,且N分期越晚预后越差。应积极治疗晚期喉鳞状细胞癌患者的颈部淋巴结。[ Objective ] To explore the impact of cervical metastasis on the survival of patients with advanced laryngeal squamous cell carcinoma. [ Methods] Between January 1990 to December 2005, 312 cases of squamous cell carcinoma of the larynx hospitalized in Cancer Center, Sun Yat-sen University were reviewed retrospectively. 141 patients （45.2%） had positive clinical cervical nodal disease （cN＋） and 171 patients （54.8%） had negative clinical cervical nodal disease （cN0） at initial presence. Survival differences according to presence or absence of clinical cervical nodal disease and N-stage were determined with Kaplan-Meier method and the log-rank test. [Results] The 5-year survival rates for cN＋ patients and cN0 were 33.7% and 60.5% （P 〈 0.001 ）. The 5-year survival rates were 40.6%, 33.6%, and 0% for cN1-cN3 lesions, respectively （P 〈 0.001）. Clinical cervical metastasis was detected in 45.2% （141/312 cases） of those individuals with advanced laryngeal squamous cell carcinoma presenting for initial clinical consultation; after therapy, those oN＋ patients （141 cases） all had positive histological cervical metastasis and 30 cases （30/171, 17.5%） of those cNO individuals had positive histological cervical metastasis. Finally, 54.8% （171/312） of our patients with histologically positive necks manifested disease to the cervical lymph nodes. [ Conclusion ] The patients presence of cervical nodal disease associated with decrease survival rate. Besides, advanced N-stage significantly correlated with worse prognosis. The cervical lymphy node of advanced laryngeal squamous cell carcinoma should be treated aggressively.

关 键 词：喉肿瘤 鳞状细胞癌 淋巴结转移 

分 类 号：R739.63[医药卫生—肿瘤] R739.87[医药卫生—临床医学]