舌体鳞癌颈淋巴结转移的规律和治疗策略  

Regularity and Therapeutic Strategy of Cervical Lymph Node Metastasis in Squamous Cell Carcinoma of the Tongue

作　　者：郭朱明[1] 张诠[1] 曾宗渊[1] 陈福进[1] 魏茂文[1] 彭汉伟[1] 许光普[1] 陈文宽[1] 王章锋[1] 

机构地区：[1]中山大学肿瘤防治中心头颈科,广东广州510060

出　　处：《癌症》2003年第3期282-285,共4页Chinese Journal of Cancer

基　　金：广东省医学科研基金项目(No.A2002226)

摘　　要：背景与目的:目前,对临床颈淋巴结阴性(cN0)的舌癌病例是否需行颈淋巴清扫术治疗仍存争议。本研究目的在于探讨舌体鳞癌的颈部淋巴结转移规律和分区性颈淋巴结清扫术应用于cN0舌癌病例的理论依据和应用原则。方法:回顾性分析1991年至1997年214例手术治疗的舌体鳞癌患者的临床资料;分析cN0pN+(病理检查淋巴结阳性)病例和cN+pN+病例的颈部转移淋巴结分布规律;比较不同分组的远期疗效;Cox回归分析法筛选影响舌体鳞癌患者预后的因素。结果:pN+病例69例,颈淋巴结转移率32.2%,其中同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占22.3%、33.5%、22.3%、4.6%、1.0%;对侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占6.6%、3.6%、3.0%、2.0%、0.5%。pN+组和pN0组5年生存率各为47%、83%(P<0.001);Cox回归分析显示影响舌体鳞癌患者预后的独立因素为T分期、N分期。结论:舌体鳞癌淋巴结转移最常见于同侧颈部Ⅰ、Ⅱ、Ⅲ区;分区性颈淋巴结清扫术对cN0病例既可起治疗的作用,又可用于评价颈部淋巴结转移状况以决定是否行全颈淋巴结清扫术。BACKGROUND &OBJECTIVE: At present, whether neck dissection should be employed in squamous cell carcinoma (SCC) of the tongue with clinically node negative neck(cN0) is still controversial. This study was designed to explore the regularity of cervical lymph node metastasis in SCC of the mobile part of the tongue, and to discuss the theories and principles of employment of selective neck dissection in cN0 cases. METHODS: A retrospective research was performed on clinical data of 214 cases of SCC of the tongue treated with surgery from 1991 to 1997. Distribution of cervical lymph node metastasis of cN0 pN+(pathologically node positive) and cN+(clinically node positive) pN+cases were analyzed; the survival rates of different groups were compared; the factors that impact the survival of SCC of the tongue were screened out by Cox regression analysis. RESULTS: Cervical lymph node metastases were found in 69 cases. The metastatic rate was 32.2%. Metastases occurred in level Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴof the ipsilateral neck were 22.3%, 33.5%, 22.3%, 4.6%, 1.0%, in level Ⅰ,Ⅱ,Ⅲ, Ⅳ,Ⅴof the contralateral neck were 6.6%, 3.6%, 3.0%, 2.0%, 0.5%, respectively. The 5 year survival rates of the pN+group and the pN0 group were 47%and 83%, respectively(P< 0.001). T stage and N stage were independent factors that impact the long term outcome of SCC of the tongue. CONCLUSION: Level Ⅰ,Ⅱ,Ⅲof the ipsilateral neck tend to be involved when cervical lymph node metastases occur. Selective neck dissection can be used to treat the cervical metastasis in cN0 cases, as well as to evaluate the cervical lymph node status in order to determine whether comprehensive neck dissection should be employed.

关 键 词：舌肿瘤 颈淋巴结转移 分区性颈淋巴结清扫术 

分 类 号：R739.86[医药卫生—肿瘤]