颈部淋巴结转移舌体鳞状细胞癌138例的预后分析

目的探讨颈部淋巴结转移（pN＋）舌体鳞状细胞癌的预后及其影响因素。方法回顾性分析138例颈部pN＋舌体鳞状细胞癌患者的临床和随访资料,采用Kaplan-Meier法计算累积生存率,采用Log-rank法比较各因素不同水平生存分布的差异,应用Cox比例风险模型进行多因素生存分析。结果全组病例5年总体生存率和无瘤生存率分别为44.4%、39.3%。单因素分析显示,影响pN＋舌体鳞状细胞癌预后的因素包括pT分期、pN分期、pTNM分期以及淋巴结有无包膜外侵犯。多因素分析显示：pTNM分期以及淋巴结有无包膜外侵犯是影响预后的独立因素。当颈淋巴结有包膜外侵犯时,术后放疗组的无瘤生存率高于无放疗组,但差异无统计学意义（P〉0.05）。结论pTNM分期以及淋巴结有无包膜外侵犯是pN＋舌体鳞状细胞癌的独立预后因素。pN＋舌体鳞状细胞癌应常规评价转移淋巴结有无包膜外侵犯。当淋巴结有包膜外侵犯时,术后放疗有可能能改善预后。

Prognostic analysis of 138 patients with pN+ tougue squamous cell carcinoma

Objective Oral tougue squamous cell carcinoma（SCC） with pathologically node positive（pN＋） have poor prognosis.This study was to analyze the prognosis of pN＋ oral tougue SCC and its influencing factors.Methods Clinical and follow-up data of 138 patients with pN＋ oral tougue SCC were reviewed.Survival rates were calculated by Kaplan-Meier.Log-rank method was used for comparision of the distribution of the different survival rates.Multivariate analysis was done by Cox proportional hazard model.Results The 5-year overall and disease-free survival rates were 44.4% and 39.3% respectively.In univariate survival analysis,pT stage,pN stage,pTNM stage,extracapsular spread（ECS） of cervical lymph nodes were relevant to the prognosis of pN＋ oral tougue SCC.Multivariate analysis showed that pTNM stage and ECS of cervical lymph nodes are the independent prognostic factors of pN＋ oral tougue SCC.When ECS of cervical lymph nodes was present,postoperative radiation seemed to make better disease-free suv ival rate,but p-value failed to demonstrate significant difference.Conclusions pTNM stage and ECS of cervical lymph nodes are the independent prognostic factors of pN＋ oral tougue SCC.As to pN＋ oral tougue SCC,ECS of cervical lymph nodes should be evaluated routinely and postoperative radiation may improve its prognosis when ECS was present.