cN0下咽鳞癌颈部淋巴结隐匿性转移及预后  

Analysis and management of occult cervical lymph node metastasis of cN0 hypopharyngeal carcinoma

作　　者：胡晨 张明 薛继尧 龚洪立 陶磊 周梁 HU Chen;ZHANG Ming;HSUEH ChiYao;GONG Hongli;TAO Lei;ZHOU Liang(Department of Otolaryngology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Otolaryngology,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031 [2]复旦大学附属中山医院青浦分院耳鼻喉科,上海201700

出　　处：《中国眼耳鼻喉科杂志》2022年第6期597-602,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市自然科学基金(17ZR1404700);上海市科委“科技创新行动计划”(16411950101)。

摘　　要：目的探讨cN0下咽鳞癌颈部淋巴结隐匿性转移的规律及处理。方法回顾分析2006年1月~2017年11月复旦大学附属眼耳鼻喉科医院耳鼻喉科收治的86例cN0下咽鳞癌患者的临床资料。采用Kaplan-Meier法绘制生存曲线,并用Log-rank检验进行验证;采用卡方检验比较不同组别淋巴结隐匿性转移率及局部复发率;采用Cox风险回归模型分析影响预后的独立因素。结果86例cN0下咽鳞癌患者的颈淋巴结隐匿性转移率为17.4%(15/86),低分化鳞癌颈淋巴结隐匿性转移率远高于中、高分化鳞癌,差异具有统计学意义(P<0.05)。随访期间,总体局部复发率为14.0%(12/86),低分化鳞癌、T3~T4期、pN+及下咽后壁型下咽鳞癌患者更易出现局部复发,差异具有统计学意义(P值均<0.05)。结论cN0下咽鳞癌患者具有较高的颈部淋巴结隐匿性转移率,尤其是低分化鳞癌患者;低分化鳞癌、T3~T4期、pN+及下咽后壁型下咽鳞癌患者更易出现局部复发,应重视cN0下咽鳞癌患者的颈清扫术和密切随访。Objective To explore the rule of occult cervical lymph nodes metastasis in clinically node negative(cN0)hypopharyngeal carcinoma.Methods From January 2006 to November 2017,the clinical data of 86 patients with cN0 hypopharyngeal carcinoma in Eye&ENT Hospital of Fudan University were analyzed retrospectively.The survival curve was analyzed by Kaplan-Meier method,and the survival rate was compared by chi-square test and Log-rank test.Results The total incidence of occult cervical lymph nodes metastasis in cN0 hypopharyngeal carcinoma was 17.4%(15/86),and the rate of poorly differentiated squamous cell carcinoma was much higher than that of moderate and high differentiated squamous cell carcinoma,with significant difference(P<0.05).The overall local recurrence rate was 14.0%(12/86).Patients with poorly differentiated squamous cell carcinoma,stage T3~T4,pN+and posterior hypopharyngeal carcinoma were more likely to have local recurrence(P<0.05).Conclusions cN0 hypopharyngeal carcinoma had a high rate of occult cervical lymph nodes metastasis,especially in those with poorly differentiated squamous cell carcinoma.Patients with poorly differentiated squamous cell carcinoma,stage T3~T4,pN+and posterior hypopharyngeal carcinoma were more likely to have local recurrence,and the comprehensive treatment and closer follow-up of these patients should be emphasized.

关 键 词：下咽肿瘤 隐匿性淋巴结转移 颈淋巴结清扫术 预后 

分 类 号：R739.63[医药卫生—肿瘤]