声门上型喉癌颈淋巴结转移方式及其对预后的影响

目的：探讨影响声门上型喉癌颈淋巴结转移的临床病理因素及颈淋巴结转移对预后的影响。方法：用x^2检验和Logistic回归分析，对55例声门上型喉癌患者的肿瘤临床病理学因素与颈淋巴结转移的关系进行回顾性分析；并对颈淋巴结转移状态，转移颈淋巴结大小、数目、累及区域、最低受累区域等病理学因素对预后的影响进行Cox回归分析。结果：单因素分析显示，肿瘤病理分级、肿瘤大小、肿瘤浸润深度与发生颈淋巴结转移有关；多因素分析显示，肿瘤病理分级、肿瘤大小与发生颈淋巴结转移明显相关；声门上型喉癌患者5年生存率为52．7％。Cox回归分析表明，临床N分期、颈淋巴结转移状态、转移颈淋巴结大小影响患者预后。结论：声门上型喉癌颈淋巴结转移的发生受原发癌病理学因素的影响，它从多个角度明显影响患者预后；对影响预后的淋巴结因素采取相应治疗措施，对提高声门上型喉癌的治疗效果具有重要意义。

Patterns and prognostic factors of cervical lymph node metastasis in supraglottic laryngeal carcinoma

OBJECTIVE: To investigate the risk factors in the prediction of cervical lymph node metastases and the cervical lymph node prognostic factors in supraglottic laryngeal carcinoma. METHOD: A retrospective study was carried out to review the histopathological data from 55 supraglottic laryngeal carcinoma patients. The relationship between histopathological parameters and cervical lymph node metastases were evaluated by means of a univariate chi2 test and multivariate stepwise logistic regression model. And the Cox regression model was used to define possible pathological parameters of cervical lymph node affecting survival including N staging, presence of cervical lymph node metastases and extracapsular nodal spread, size and number of positive neck nodes, and levels of positive neck nodes. RESULT: In a univariate analysis, it was confirmed that the following variables correlated to cervical lymph node metastases, i.e., depth of primary tumor infiltration, size and histological grade of primary tumor. In a multivariate analysis, the most significant risk factors for cervical lymph node metastases were the size and histological grade of primary tumor. The overall 5-year survival rate of patients with supraglottic laryngeal carcinoma was 52.7%. In a Cox regression analysis, N staging, size of positive neck nodes, presence of cervical lymph node metastasis and extracapsular nodal spread were found to be related to the prognosis of supraglottic laryngeal carcinoma. CONCLUSION: Cervical lymph node metastasis is one of the most significant prognostic factors of supraglottic laryngeal carcinoma. The identification of patients at risk for cervical lymph node metastasis and the management of the neck by coping with pathological factors of neck node affecting survival are crucial steps to improve the effect of supraglottic laryngeal carcinoma treatment.