428例鼻咽癌患者颈部及Ⅴ区后缘转移淋巴结位置分布规律研究  

Regulation of metastatic cervical lymph nodes in 428 cases of nasopharyngeal carcinoma:metastasis distribution of posterior to level Ⅴ

作　　者：蒋朝阳[1,2] 张涛[1,2] 高辉[2] 张伶[2] 

机构地区：[1]西南医科大学附属医院肿瘤科,四川省泸州市646000 [2]成都军区总医院放疗科

出　　处：《中国肿瘤临床》2016年第19期855-859,共5页Chinese Journal of Clinical Oncology

基　　金：成都市科技惠民技术研发项目(编号:2014-HM01-00087-SF)~~

摘　　要：目的:分析鼻咽癌患者颈部及Ⅴ区后缘淋巴结的转移规律,指导鼻咽癌颈部放疗靶区的勾画。方法:回顾性分析2013年2月至2016年4月就诊于成都军区总医院428例经病理确诊为鼻咽癌的患者,所有患者均行颅底至锁骨下缘的增强CT模拟扫描。淋巴结分区采用RTOG等推荐的分区指南(2013版),由两位医师共同阅片对颈部及Ⅴ区后缘的转移淋巴结进行分析,并选取1例N0期的鼻咽癌患者作为标准,参照Ⅴ区后缘正常解剖结构位置及比例,将428例患者中有Ⅴ区后缘转移淋巴结的中心点勾画于标准病例的定位CT图像上,采用SPSS 19.0软件分析Ⅴ区后缘淋巴结转移与其余各区淋巴结之间的相关性,并分析Ⅴ区后缘转移淋巴结的位置及特点。结果:428例患者中381例(89.0%)出现淋巴结转移,转移概率最高的前4位淋巴结区依次为Ⅱb(75.2%)、Ⅶa(60.3%)、Ⅱa(59.6%)、Ⅲ(42.0%);21例(4.9%)出现Ⅴ区后缘淋巴结转移,共统计Ⅴ区后缘转移淋巴结32枚,各枚淋巴结中心点在标准患者上距斜方肌前缘的垂直距离均值为16 mm。相关性分析提示Ⅴ区后缘淋巴结转移与同侧Ⅴa区相关(P=0.001)。结论:鼻咽癌颈部淋巴结按照从上到下,由近及远的顺序转移,跳跃性转移的发生率低;Ⅴ区后缘淋巴结转移与同侧Va区阳性相关;Va区淋巴结转移时,同侧V区后界的勾画应适当后移至斜方肌前缘后25 mm。Objective：To retrospectively investigate the regulation of cervical and posterior to level V （PLV） lymph node metastasis on clinical target delineation in radiotherapy for nasopharyngeal carcinoma （NPC）. Methods：A total of 428 NPC cases from February 2013 to April 2016 were subjected to enhanced CT scan from the base of the skull to the clavicle for pathological diagnosis. A deputy chief physician and an attending physician assessed the nodal distribution in each level in accordance with the RTOG guidelines proposed in 2013. The central point of the metastatic lymph nodes of PLV in the patients were recreated proportionally on the CT images of a stan-dard patient with N0 NPC in reference to the normal anatomy of the PLV area. SPSS 19.0 was used to analyze the correlation between PLV and the other levels. Moreover, the nodal location and characteristics of PLV were analyzed. Results：Among the 428 patients, 381 （89.0%） showed nodal involvement. The top four metastatic probabilities were presented as follows：Ⅱb （75.2%）,Ⅶa （60.3%）,Ⅱa （59.6%）, andⅢ（42.0%）. Up to 21 （4.9%） patients exhibited nodal involvement of PLV with 32 nodes. The mean vertical distance of all central points of PLV from the anterior border of the trapezius was 16 mm. Correlation analysis indicated the nodal involvement of PLV with the ipsilateral level Va （P=0.001）. Conclusion：NPC showed a high probability of nodal metastasis. Nodes were mostly metasta-sized from the upper to the lower level, as well as from the proximal to the distal area. The leap metastasis rate was very low. The nod-al involvement of PLV correlated with the ipsilateral metastasis of level Va. Thus, the ipsilateral delineation of the posterior border of level V should be contoured to 25 mm far from the anterior surface of the trapezius during the nodal involvement of level Va.

关 键 词：鼻咽癌 淋巴结转移 Ⅴ区后缘 放射治疗 

分 类 号：R739.63[医药卫生—肿瘤]