口底鳞癌影响颈淋巴结转移的因素分析  

Analysis of the factors influencing cervical lymphatic metastasis of the floor of mouth carcinoma

作　　者：吴雪溪[1] 唐平章[1] 祁永发[1] 徐震纲[1] 

机构地区：[1]中国医学科学院附属肿瘤医院头颈外科,北京100021

出　　处：《中国癌症杂志》2003年第5期467-468,471,共3页China Oncology

摘　　要：目的 :探讨口底鳞癌影响颈淋巴结转移的局部因素及其与预后的关系。方法 :回顾性分析我院 1983～ 1998年治疗的 6 5例口底鳞癌患者 ,分析肿瘤部位、直径、口腔侵犯、病理分化与颈部淋巴结转移及预后的关系。结果 :6 5例患者的颈部淋巴结转移率为 4 6 .2 % (30 / 6 5 ) ,颏下、颌下区 (Ⅰ区 )淋巴结转移占 96 .6 % (2 9/ 30 )。前口底肿瘤 4 5例 ,后口底肿瘤 2 0例 ,淋巴结转移率分别为 6 2 .2 %和 4 0 .0 % (P =0 .0 96 ) ;肿瘤直径在 3厘米以上与以下 ,淋巴结转移率分别为 5 9.5 %和 2 1.7% (P =0 .0 0 3) ;侵犯舌与未侵犯舌 ,淋巴结转移率分别为 4 6 .8%和 4 4 .4 % ;侵犯牙龈与未侵犯牙龈 ,淋巴结转移率分别为 6 0 .0 %和 4 2 .0 % ;低分化鳞癌与中、高分化鳞癌的淋巴结转移率分别为 76 .5 %和 4 2 .1% (P =0 .0 18)。 6 5例患者五年生存率为 4 6 .4 % ,其中无淋巴结转移者五年生存率为6 1 4 % ,有淋巴结转移者为 2 8.9% (P =0 .0 0 13)。结论 :口底鳞癌局部因素中 ,肿瘤直径大于 3厘米、侵犯舌及牙龈、病理为低分化鳞癌的有较高的颈淋巴结转移率 。Purpose:To investigate the local factors that influenced cervical lymphatic metastasis and prognosis of the floor of mouth carcinoma.Methods:A retrospective study was undertaken of 65 patients with squamous cell carcinoma of floor of mouth, who were treated between 1983 and 1998. Local factors including the tumor location, the tumor size, local invasion and pathological differentiation were investigated for the correlation with cervical lymphatic metastasis and prognosis of the disease.Results:Cervical lymphatic metastasis was 46.2% (30/65) for these 65 patients, and 96.6% of the involved lymph nodes were located in level Ⅰ(submandibular region) of the neck. Of these 65 patients, cervical lymphatic metastasis was 62.2% and 40.0% for 45 anterior and 20 posterior floor of mouth carcinoma, respectively ( P = 0 .096).Cervical metastasis was 59.5% and 21.7% for tumor size greater than or less than 3 cm, respectively ( P = 0.003).Cervical metastasis was 46.8% and 44.4% for tumors invading the tongue or not, respectively.Cervical metastasis was 60 0% and 42 0% for tumors invading the gum or not, respectively.Cervical metastasis was 76.5% for the poorly differentiated and was 42.1% for the moderately and well differentiated squamous cell carcinoma ( P = 0.018). The overall 5 years survival was 46.4% for the 65 patients. The 5 years survival was 61.4% for these without cervical metastasis and 28.9% for these with cervical metastasis ( P = 0.0013).Conclusions:The local factors such as the tumor size greater than 3 cm, tumor invasion to the tongue and the gum, and the poorly differentiated squamous cell carcinoma of floor of mouth increased the incidence of cervical metastasis, and therefore adversely influenced the prognosis.

关 键 词：口底肿瘤 鳞癌 颈部淋巴结转移 预后 口腔侵犯 

分 类 号：R739.8[医药卫生—肿瘤]