行根治性切除治疗初诊T3~T4期喉癌患者同侧及对侧颈部淋巴结转移的危险因素分析  

Risk factors and characteristics of ipsilateral and contralateral cervical lymph node metastasis in primary T3-T4 laryngeal cancer treated with radical surgery

作　　者：胡愈强 刘冰[1] 仲畅 程良军[1] 邹明臻 HU Yuqiang;LIU Bing;ZHONG Chang;CHENG Liangjun;ZOU Mingzhen(Department of Otolaryngology,Central Hospital of Xuzhou City,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院耳鼻喉科,江苏徐州221009

出　　处：《临床肿瘤学杂志》2022年第11期1009-1014,共6页Chinese Clinical Oncology

基　　金：徐州市科学技术资助项目(KC16SL106)。

摘　　要：目的探讨行根治性切除治疗初诊T_(3)~T_(4)期喉癌患者同侧及对侧颈部淋巴结转移的影响因素及潜在规律。方法回顾性分析2015年1月至2021年1月行根治性手术治疗的喉癌患者136例,观察手术情况及术后淋巴结转移情况,采用Logistic回归模型评价影响局部晚期喉癌同侧及对侧颈部淋巴结转移的独立因素。结果136例患者中,68例术前临床分期为cN_(0)期,颈部清扫后仅10例病理证实存在淋巴结转移,其他临床淋巴结阳性均经病理证实为阳性。声门上型、声门型、声门下型及贯声门型亚组病理淋巴结转移率分别为58.3%(60/103)、38.1%(8/21)、66.7%(2/3)、88.9%(8/9);cN_(0)期、cN_(1)期、cN_(2)期和cN_(3)期亚组病理淋巴结转移率分别为14.7%(10/68)、100.0%(14/14)、100.0%(53/53)、100.0%(1/1);高分化、中分化和低分化亚组病理淋巴结转移率分别为28.6%(6/21)、60.9%(53/87)、67.9%(19/28);不同解剖学分型、临床N分期及组织分化程度亚组病理淋巴结转移率比较,差异有统计学意义(P<0.05)。单侧型组、侵犯中线型及巨大或中央型组双侧颈部淋巴结转移的发生率分别为19.4%(7/36)、25.6%(11/43)、24.6%(14/57),组间比较差异无统计学意义(P>0.05)。Logistic多因素分析显示,同侧Ⅲ区转移和cN_(0)分期是影响对侧颈部淋巴结转移的独立因素(P<0.05);同侧Ⅱ区和Ⅲ区转移是影响同侧Ⅳ区淋巴结转移的独立因素(P<0.05)。局部晚期喉癌患者声门下区侵犯与Ⅵ区转移发生风险有关(P=0.003)。结论双侧颈部Ⅱ区和Ⅲ区为初治T_(3)~T_(4)期喉癌病理淋巴结转移高危区域,Ⅳ区和Ⅴ区转移相对少见,同时cN_(0)期患者出现对侧颈部淋巴结转移风险更低。Objective To investigate the risk factors and characteristics of ipsilateral and contralateral cervical lymph node metastasis in primary T_(3)-T_(4) laryngeal cancer treated with radical surgery.Methods A total of 136 primary T_(3)-T_(4) laryngeal cancer treated with radical surgery were chosen from January 2015 to January 2021.The operation and postoperative lymph node metastasis were analyzed.Logistic regression model was used to evaluate the independent influencing factors of ipsilateral and contralateral neck lymph node metastasis of locally advanced laryngeal cancer.Results There were only 10 cases with pathological lymph node metastasis after neck dissection in 68 cases with clinical stage cN_(0) before operation,and other clinical lymph node positive pathologies were confirmed to be positive.The pathological lymph node metastasis rates of supraglottic type,glottic type,subglottic and transglottic type were 58.3%(60/103),38.1%(8/21),66.7%(2/3),88.9%(8/9),respectively.The pathological lymph node metastasis rates of cN_(0),cN_(1),cN_(2) and cN_(3) subgroups were 14.7%(10/68),100.0%(14/14),100.0%(53/53),100.0%(1/1),respectively.The pathological lymph node metastasis rates of well differentiated,moderately differentiated and poorly differentiated subgroups were 28.6%(6/21),60.9%(53/87),67.9%(19/28),respectively.There were significant difference in pathological lymph node metastasis rate among subgroups with different anatomical types,clinical N stages and pathological differentiation degree(P<0.05).The incidence of bilateral neck metastasis in unilateral type group,medium invasion type group and giant or central type group was 19.4%(7/36),25.6%(11/43)and 24.6%(14/57),without statistic significance(P>0.05).Multivariate analysis by Logistic regression model showed that ipsilateral zone III metastasis and cN_(0) stage were independent influencing factors in contralateral cervical lymph node metastasis(P<0.05);ipsilateral zone II and zone III metastasis were independent influencing factors in ipsilateral zone IV ly

关 键 词：喉癌 淋巴结转移 危险因素 

分 类 号：R739.65[医药卫生—肿瘤]