下咽鳞状细胞癌咽后淋巴结转移的临床分析  

Clinical analysis of retropharyngeal lymph node metastasis in patients with hypopharyngeal squamous cell carcinoma

作　　者：冯守昊 吕正华[1] 马聚珂[1] 刘善凤[2] 于学文 魏玉梅[3] 靖培航 刘旭良[1] 周超[1] 洒娜 徐伟[1] Feng Shouhao;Lyu Zhenghua;Ma Juke;Liu Shanfeng;Yu Xuewen;Wei Yumei;Jing Peihang;Liu Xuliang;Zhou Chao;Sa Na;Xu Wei(Department of Head and Neck Surgery,Shandong Provincial ENT Hospital,Shandong University,Jinan 250022,China;Department of Radiology,Shandong Provincial ENT Hospital,Shandong University,Jinan 250022,China;Department of Head and Neck Radiotherapy,Shandong Provincial ENT Hospital,Shandong University,Jinan 250022,China)

机构地区：[1]山东省耳鼻喉医院头颈外科山东大学,济南250022 [2]山东省耳鼻喉医院影像科山东大学,济南250022 [3]山东省耳鼻喉医院头颈放疗科山东大学,济南250022

出　　处：《中华肿瘤杂志》2023年第11期955-961,共7页Chinese Journal of Oncology

基　　金：海南省重大科技计划项目(ZDKJ202005);山东省医药卫生科技发展计划项目(202009010992、202009011528)。

摘　　要：目的探讨下咽鳞状细胞癌(简称鳞癌)咽后淋巴结转移的发生情况及影响因素,评估术前增强CT对下咽鳞癌咽后淋巴结转移的诊断效能及咽后淋巴结转移对下咽鳞癌患者预后的影响。方法对2014年1月至2019年12月于山东省耳鼻喉医院头颈外科首选手术治疗并同期行咽后淋巴结探查、清除的原发下咽鳞癌患者398例进行回顾性分析,采用多因素logistic回归分析明确咽后淋巴结转移的影响因素,采用多因素Cox回归分析明确咽后淋巴结转移与下咽鳞癌患者预后的关系。由2位高年资头颈影像诊断医师对术前增强CT资料完整的218例患者进行咽后淋巴结评估,并与术后病理结果进行比较分析。结果398例患者中,54例(13.6%)术后病理证实咽后淋巴结转移。术前增强CT诊断咽后淋巴结转移的灵敏度为34.6%,特异度为91.1%,准确率为84.4%。多因素logistic回归分析显示,原发部位、病理N分期为下咽鳞癌咽后淋巴结转移的独立影响因素,原发于下咽后壁区(OR=4.83,95%CI:1.27~18.40)、N2期(OR=6.30,95%CI:2.25~17.67)、N3期(OR=26.89,95%CI:5.76~125.58)下咽鳞癌患者易发生咽后淋巴结转移。398例下咽鳞癌患者的5年总生存率为50.4%,无病生存率为48.3%。多因素Cox回归分析显示,T分期、N分期、咽后淋巴结转移和放疗既是下咽鳞癌患者总生存时间的独立影响因素(T分期:HR=1.28,95%CI:1.06~1.54;N分期:HR=1.26,95%CI:1.14~1.40;咽后淋巴结转移:HR=2.13,95%CI:1.47~3.08;放疗:HR=0.54,95%CI:0.38~0.76),也是下咽鳞癌患者无病生存时间的独立影响因素(T分期:HR=1.26,95%CI:1.06~1.51;N分期:HR=1.25,95%CI:1.13~1.37;咽后淋巴结转移:HR=2.24,95%CI:1.56~3.21;放疗:HR=0.55,95%CI:0.40~0.77)。结论下咽鳞癌易发生咽后淋巴结转移,增强CT作为诊断咽后淋巴结转移的技术手段,准确率不高,价值有限。原发于下咽后壁区、病理N分期为N2期、N3期是下咽鳞癌患者发生咽后淋巴结转移的高危因素Objective To analyze the incidence and the related risk factors of retropharyngeal lymph node metastasis in patients with hypopharyngeal squamous cell carcinoma,evaluate the accuracy of preoperative enhanced CT in judging retropharyngeal lymph node metastasis,and investigate the impact of retropharyngeal lymph node metastasis on the prognosis.Methods Retrospective analyses were made on 398 patients with hypopharyngeal squamous cell carcinoma who underwent surgery as the primary therapy and accepted retropharyngeal lymph node exploration and clearance during surgery in Shandong Provincial ENT Hospital from January 2014 to December 2019.Multivariate logistic regression analysis was used to clarify the related risk factors of retropharyngeal lymph node metastasis.Multivariate Cox regression analysis was used to investigate the impact of retropharyngeal lymph node metastasis on prognosis.The retropharyngeal lymph nodes of 218 cases with available preoperative enhanced CT images were evaluated by two experienced radiologists and compared with postoperative pathological results.Results Retropharyngeal lymph node metastasis were confirmed in 54 of 398(13.6%)cases according to postoperative pathology.The sensitivity and specificity of preoperative enhanced CT in the diagnosis of retropharyngeal lymph node metastasis were 34.6%and 91.1%,respectively,and the overall accuracy was 84.4%.Multivariate logistic regression analysis showed that the site of the primary lesion and pathological N stage were independent risk factors for retropharyngeal lymph node metastasis in hypopharyngeal squamous cell carcinoma.Patients with primary lesion located in the posterior wall of hypopharynx(OR=4.83,95%CI:1.27-18.40),N2 stage(OR=6.30,95%CI:2.25-17.67),and N3 stage(OR=26.89,95%CI:5.76-125.58)were prone to retropharyngeal lymph node metastasis.The 5-year overall survival rate of the 398 patients was 50.4%,and the 5-year disease-free survival rate was 48.3%.Multivariate Cox regression analysis showed that T stage,N stage,retropharyngeal lym

关 键 词：下咽肿瘤 咽后淋巴结 手术治疗 计算机断层扫描 预后 

分 类 号：R739.63[医药卫生—肿瘤]