牙龈鳞癌颈部淋巴结隐匿性转移的相关因素分析及临床意义  

Analysis of related factors and clinical significance of occult cervical lymph node metastasis in gingival squamous cell carcinoma

作　　者：石艳凤 崔子峰 赵建广[2] 杨凯成[2] 陈彦平 SHI Yanfeng;CUI Zifeng;ZHAO Jianguang;YANG Kaicheng;CHEN Yanping(Luannan County Hospital Ent Department,TangShan 063500)

机构地区：[1]河北唐山滦南县医院五官科,063500 [2]河北医科大学第四医院口腔科

出　　处：《现代口腔医学杂志》2021年第5期298-301,330,共5页Journal of Modern Stomatology

基　　金：河北省卫生厅青年科技课题资助(20201064)。

摘　　要：目的探讨临床颈部淋巴结为阴性(clinically negative cervical lymph node,cN0)的牙龈鳞状细胞癌(gingival squamous cell carcinoma,GSCC)患者发生颈部淋巴结隐匿性转移(occult lymphatic metastasis,OLM)的相关影响因素和与预后的关系,为临床对GSCC cN0患者颈部淋巴结的处理提供参考。方法对178例行Ⅰ~Ⅳ区选择性颈淋巴清扫术(elective neck dissection,END)的GSCC cN0患者颈部OLM情况与临床病理因素的关系采用卡方检验或Fisher检验,应用Kaplan-Meier法行生存分析,利用Cox回归模型对颈部OLM相关的临床病理资料进行单因素和多因素分析。结果178例GSCC cN0患者的颈部OLM转移率为24.16%(43/178),其中I、Ⅱ区分别为15.17%(27/178)、6.18%(11/178),Ⅲ区、Ⅳ区分别为1.12%(2/178)、1.69%(3/178);颈部OLM转移率与性别、癌前病变、病变持续时间、T分期以及发病部位无相关性(P>0.05),与年龄和肿瘤分化程度存在相关性(P<0.05);颈部OLM、T分期和肿瘤分化程度可作为影响GSCC患者5年生存的独立危险因素(P<0.05)。结论颈部Ⅰ、Ⅱ区是GSCC cN0患者OLM发生的主要区域。年轻(≤45岁)或组织学分化程度较低可作为同期行END的重要参考因素。Objective To explore the clinically negative cervical lymph node(cN0)gingival squamous cell carcinoma(GSCC)patients with cervical lymphatic metastasis(occult lymphatic metastasis,OLM)related factors and the relationship with prognosis,provide reference for clinical treatment of cervical lymph nodes in GSCC cN0 patients.Methods Chi-square test or Fisher test was used for 178 cases of GSCC cN0 patients who underwent elective neck dissection(END)of zoneⅠ~Ⅳ,use Kaplan-Meier method to perform survival analysis,use Cox regression model to analyze clinical pathological data related to cervical OLM.Results The cervical OLM metastasis rate of178 cases of GSCC cN0 patients was 24.16%(43/178).Among them,districts I andⅡare 15.17%(27/178)and6.18%(11/178),respectively;districtsⅢandⅣare 1.12%(2/178)and 1.69%(3/178)respectively.The rate of cervical OLM metastasis has no correlation with gender,precancerous lesions,duration of lesions,T stage,and location of onset(P>0.05),but is correlated with age and tumor differentiation(P<0.05).Neck OLM,T staging and tumor differentiation can be used as independent risk factors affecting the 5-year survival of GSCC patients(P<0.05).Conclusion The neck regionsⅠandⅡare the main areas where OLM occurs in GSCC cN0 patients.Young patients(≤45 years)or patients with low histological differentiation can be used as an important reference factor for END during the same period.

关 键 词：牙龈鳞状细胞癌 颈部淋巴结隐匿性转移 临床病理 预后 

分 类 号：R739.8[医药卫生—肿瘤]