口腔黏膜恶性黑色素瘤颈部淋巴结转移规律及颈部预防治疗的价值  

Patterns of regional spread and the value of elective neck treatment for oral mucosal melanoma

作　　者：孙士然 黄晓东 张烨 张世平 王凯 曲媛 吴润叶 刘清峰 陈雪松 肖建平 罗京伟 徐国镇 髙黎 易俊林 Sun Shiran;Huang Xiaodong;Zhang Ye;Zhang Shiping;Wang Kai;Qu Yuan;Wu Runye;Liu Qingfeng;Chen Xuesong;Xiao Jianping;Luo Jingwei;Xu Guozhen;Gao Li;Yi Junlin(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,10002

出　　处：《中华放射肿瘤学杂志》2020年第10期837-841,共5页Chinese Journal of Radiation Oncology

摘　　要：目的分析口腔黏膜恶性黑色素瘤(OMM)颈部淋巴结转移规律以及颈部预防治疗的价值。方法回顾性分析中国医学科学院肿瘤医院1984-2016年间收治的61例无远处转移的OMM病例的颈部淋巴结转移规律,颈部预防治疗疗效,失败模式及预后因素。结果OMM颈部淋巴结转移率为55.7%。Ⅰb区是最常见的颈部淋巴结转移区域,占颈部淋巴结转移患者的76%,其次是Ⅱ区和Ⅲ区。对于cN0患者,接受至少同侧Ⅰb-Ⅲ区颈部预防治疗和未接受的5年无区域复发生存率分别为91.7%和52.4%(P=0.036),接受至少同侧Ⅰb-Ⅲ区颈部预防治疗能将区域失败率由46%降至6%(P=0.035)。发生区域失败患者中93%发生在Ⅰb区,50%发生在Ⅱ区,36%发生在Ⅲ区。结论OMM颈部淋巴结转移率较高,淋巴结引流具有一定规律性,最常见转移和复发部位均为Ⅰb-Ⅲ区。对于cN0的OMM,推荐至少包括同侧颈部Ⅰb-Ⅲ区的预防治疗。Objective To investigate the patterns of regional lymphatic spread and the value of elective neck treatment(ENT)in oral mucosal melanoma(OMM).Methods In this retrospective analysis,61 OMM patients with no distant metastasis treated in Cancer Hospital of Chinese Academy of Medical Sciences between 1984 and 2016 were recruitred.The regional lymph node distribution of cN+disease,the value of ENT in cN0 disease,the failure patterns and prognostic factors were retrospectively analyzed.Results Overall,55.7%of the patients were clinical/pathological cN+.The most frequently involved locations were the levelⅠb(76%),followed by levelⅡand levelⅢ.For cN0 patients,the 5-year regional failure-free survival rate was 91.7%in patients who received at least ipsilateral levelⅠb-ⅢENT and 52.4%in patients who did not receive at least ipsilateral levelⅠb-ⅢENT(P=0.036).The regional failure rate was 6%for patients treated with at least ipsilateral leveⅠb-ⅢENT,while in their counterparts who did not receive at least ipsilateral levelⅠb-ⅢENT was 46%(P=0.035).For the regional failure pattern,the most frequently failure sites were levelⅠb(93%),levelⅡ(50%)and levelⅢ(36%).Conclusions The cervical lymph node metastasis rate is relatively high in OMM patients.The pathway of regional LN spread follows a regular pattern.The most frequently involved regions for clinical/pathological cN+and regional failure are both levelⅠb-Ⅲ.Elective treatment including at least ipsilateral levelⅠb-ⅢENT should be recommended for OMM patients with cN0.

关 键 词：黑色素瘤 淋巴结转移规律 预防疗法 

分 类 号：R739.85[医药卫生—肿瘤]