甲状腺乳头状癌颈淋巴结转移规律与手术方式的选择

目的:从甲状腺乳头状癌颈部淋巴结转移规律探讨其最佳手术方式.方法:回顾性分析我院近三年367例甲状腺乳头状癌(papillary thyriod carcinoma,PTC)根治术患者的临床及病理资料.结果:颈淋巴结总转移率为77.11%(283/367),中央区(VI区)转移率为 70.30%(258/367),颈侧区(Ⅱ、Ⅲ、Ⅳ、Ⅴ区)转移率为 62.67%(230/367),颈侧区中的Ⅱ区转移率最高60.49%(222/367).发病年龄、原发灶个数、肿瘤是否累及被膜、癌灶直径、肿瘤边界是否清晰、癌灶位置、超声血流信号分级、癌症是否合并桥本氏甲状腺炎或结节性甲状腺肿对颈部淋巴结转移的影响差异均有统计学意义(P<0.05);性别因素及癌灶是否钙化对颈部淋巴结转移的影响差异无统计学意义(P>0.10),经logistic回归分析发现,肿瘤是否累及被膜对颈部淋巴结转移的影响因素最大.结论:VI区是甲状腺乳头状癌最常见的转移部位,术中应常规清除,其次依次为Ⅱ、Ⅲ、Ⅳ、Ⅴ区.对于患者原发肿瘤若累及包膜、或多发病灶、或癌灶直径>1 cm及患者发病年龄<45岁等应同时做颈侧区清扫.     

Surgical management of squamous cell carcinoma of the floor of the mouth

A retrospective review is presented of 76 patients, referred to the National Cancer Center Hospital, Tokyo, who underwent surgical management for squamous cell carcinoma of the floor of the mouth during the period March, 1969, to May, 1988. Of the 76 patients, 34 (45%) were treated by surgery alone, 19 (25%) by cryosurgery and 23 (30%) by a combination of surgery and another treatment modality, either irradiation (22 patients) or chemotherapy (one patient). Fifty-three percent of the patients had stage III or IV disease. Twenty-two patients (29%) developed recurrent disease during follow-up. Eighty-five percent of the treatment failures were identified within 24 months of treatment. The most common site of recurrence, seen in 14 out of 22 cases, was the neck. The actuarial five-year survivals for patients were: stage I disease, 96%; stage II, 79%; stage III, 66%; stage IV, 49%. Recent technical advances, allowing extensive resection and reconstruction in the surgical management of this kind of tumor, have improved the prognosis even for patients with advanced disease.     

Sentinel lymph node biopsy as guidance for central neck dissection in patients with papillary thyroid carcinoma

BACKGROUND.

Occult lymph node metastasis of papillary thyroid carcinoma (PTC) can be detected by sentinel lymph node (SLN) biopsy, but studies in larger patient cohorts undergoing complete central neck dissection may be required to assess the diagnostic accuracy of SLN. Therefore, the authors prospectively assessed the usefulness of SLN biopsy for the detection of central lymph node metastasis in patients with differentiated PTC who had no suspicious cervical lymphadenopathy.

METHODS.

After peritumoral injection of methylene blue, SLN biopsy was performed in 50 patients with newly diagnosed PTC who had no palpable or ultrasound (US)‐detected lymph node involvement. After SLN biopsy, all patients underwent total thyroidectomy and central neck dissection. The diagnostic accuracy of intraoperative SLN sampling was calculated by comparison with the final pathologic diagnosis.

RESULTS.

SLNs were identified in 46 of 50 patients (92%); of these, 14 SLNs were positive and 32 SLNs were negative on intraoperative frozen sections. One patient had a positive SLN in the jugular region and subsequently underwent modified radical neck dissection. Final pathologic examination revealed that 18 patients (36%), including 4 who had negative SLNs, had central lymph node metastasis. Thus, the sensitivity, specificity, accuracy, and positive and negative predictive values of SLN biopsy were 77.8%, 100%, 92%, 100%, and 88.9%, respectively. Temporary and permanent hypocalcemia developed in 19 patients and 1 patient, respectively. There were no direct complications of SLN sampling.

CONCLUSIONS.

SLN biopsy in patients with PTC without gross clinical or US lymph node involvement was able to detect occult metastasis with high accuracy and may have the potential to select patients who require central neck dissection. Cancer 2008. © 2008 American Cancer Society.     

舌体鳞癌颈淋巴结转移的规律和治疗策略

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。     

放射治疗头颈部恶性肿瘤疗效分析

分析１９９５年１２月～１９９８年９月收治的８９例头颈部恶性肿瘤患者放射治疗的疗效,并探讨有无颈淋巴结转移对预后的影响。有颈部淋巴结转移３８例远途转移率３９．７％显著高于５１例无颈淋巴结转移组的 ５．８８％（Ｐ＜０．０１）。前者生存率明显低于后者（ Ｐ＜０．０１）。     

56例同时性多原发食管鳞癌淋巴结转移因素分析

目的:探讨同时性多原发食管鳞癌(synchronous multiple primary esophageal squamous cell carcinoma,SMESC)淋巴结转移的特点及预后因素。方法:收集2011年1月至2018年12月收治的56例SMESC患者的临床病例资料,回顾分析各部位的淋巴结转移率,研究不同癌灶浸润深度、长度等因素对淋巴结转移的影响。结果:56例SMESC患者中34例有淋巴结转移,淋巴结转移率为60.7%,颈部、上、下纵隔和腹部的淋巴结转移率分别为16.7%、34.7%、32.7%和38.2%。不同癌灶部位淋巴结转移规律不同,但在上、下纵隔及腹部均有广泛转移。单因素分析结果显示,淋巴结转移与癌灶长度及浸润深度有关(P<0.05)。多因素分析结果表明,原发癌灶浸润深度和清扫淋巴结数目是淋巴结转移的独立预后因素。结论:食管癌McKeown术式及系统淋巴结清扫是目前治疗SMESC的最佳治疗手段。     

头颈肿瘤颈淋巴结清扫的手术选择

作为治疗与预防头颈恶性肿瘤颈部淋巴结转移的首要方法,颈淋巴结清扫术经过一百多年的发展,已经日趋规范合理。但是,由于头颈恶性肿瘤的种种特殊性导致其颈部淋巴结转移有较大的不确定性,头颈外科医师在施行原发灶手术时,往往会面临是否需要行颈淋巴结清扫术、如何确定颈淋巴结清扫范围的困惑。根据常见头颈恶性肿瘤的颈淋巴结转移特性及手术对患者的创伤程度,梳理出当前较为规范的颈淋巴结清扫术术式,为头颈外科医师提供参考,有助于改善头颈恶性肿瘤颈部淋巴结治疗和预防的总体效果。     

鼻咽癌颈部淋巴结转移针吸细胞学检查的临床意义

目的 探讨针吸细胞学检查诊断鼻咽癌颈部淋巴结转移的价值，对其细胞形态学特征进行总结。 方法 对经临床与病理学证实，细胞学检查为鼻咽癌颈部淋巴结转移的病例进行回顾性分析。 结果 全部病例无一例假阳性。结论 针吸细胞学检查是鼻咽癌颈部淋巴结转移的定性检查方法，对早期发现、确诊鼻咽癌特别是无鼻咽症状的病例具有较高的价值，有快速、安全、准确等优点。     

N1S3: A revised staging system for head and neck cutaneous squamous cell carcinoma with lymph node metastases

BACKGROUND.

A staging system was designed for metastatic cutaneous squamous cell carcinoma (SCC) that would incorporate the parotid as a regional level and facilitate a better prognostic discrimination between subgroups.

METHODS.

A retrospective review of clinical and pathological information of patients treated for metastatic cutaneous SCC to the parotid and/or neck was conducted. Potential prognostic factors were analyzed using univariate and multivariate analyses. A staging system was elaborated and externally validated.

RESULTS.

Two hundred fifteen patients were included. All patients had surgery as their primary treatment; 148 had parotidectomy with neck dissection, 50 parotidectomy alone, and 18 neck dissection alone. One hundred seventy‐five patients received postoperative radiotherapy. On univariate analysis, the number of involved lymph nodes (P < .001), maximal size (P = .01), and extracapsular spread (P = .003) were found to be significant predictors of survival. On Cox regression, the number of involved lymph nodes as single or multiple (P = .006) was significant. The N1S3 staging system incorporates involved lymph nodes from parotid and neck (single or multiple) and the size (< or >3 cm). This system demonstrates significant predictive capacity for locoregional control (P < .001), disease‐specific survival (P<.0001), and overall survival (P<.0001). N1S3 was tested on a different cohort of 250 patients, and the results confirmed those obtained from our primary analyses.

CONCLUSIONS.

The N1S3 system stages patients according to the number of involved lymph nodes and size, and incorporates parotid as 1 of the regional levels. These 2 predictors are easily applied on both clinical and pathological data. Cancer 2010. © 2010 American Cancer Society.     

舌体鳞癌隐匿性颈淋巴结转移的外科治疗探讨

背景与目的:对于临床颈淋巴结阴性(cN0)的舌癌颈部的处理一直存在争议,本研究旨在探讨cN0舌体鳞癌颈部的合理治疗方案。方法:回顾性分析187例手术前后未行放、化疗的cN0舌体鳞癌初诊患者的临床资料;分析颈部隐匿性淋巴结转移规律和隐匿性淋巴结转移及预后的影响因素,以及颈部不同处理方式的控制情况。结果:隐匿性淋巴结转移率为23.0%,其最常见的位置在同侧颈Ⅱ区,83.0%的隐匿性淋巴结转移分布在同侧颈Ⅰ、Ⅱ、Ⅲ区;病理分级是影响隐匿性淋巴结转移的独立因素;隐匿性淋巴结转移为影响cN0舌癌患者预后的独立因素;肩胛舌骨肌上清扫术的颈部复发率为6.7%。结论:肩胛舌骨肌上颈清扫术是cN0舌体鳞癌患者有效而安全的治疗措施。     

Upregulation of sialidase NEU3 in head and neck squamous cell carcinoma associated with lymph node metastasis

Regional lymph node metastasis in head and neck squamous cell carcinoma (HNSCC) is a crucial event for its progression, associated with a high rate of mortality. Sialidase, a key enzyme for the regulation of cellular sialic acids through catalyzing the initial step of degradation of glycoproteins and glycolipids, has been implicated in cancer progression. To facilitate the development of novel treatments for HNSCC, we have investigated whether sialidase is involved in the progression of this cancer. We found plasma membrane‐associated sialidase (NEU3) to be significantly upregulated in tumor compared to non‐tumor tissues; particularly, an increase in its mRNA levels was significantly associated with lymph node metastasis. To understand the mechanisms, we analyzed the NEU3‐mediated effects on the malignant phenotype using squamous carcinoma HSC‐2 and SAS cells. NEU3 promoted cell motility and invasion, accompanied by the increased expression of MMP‐9, whereas NEU3 silencing or the activity‐null mutant did not. NEU3 enhanced phosphorylation of epidermal growth factor receptor (EGFR), and an EGFR inhibitor, AG1478, abrogated the NEU3‐induced MMP9 augmentation. These findings identify NEU3 as a participant in HNSCC progression through the regulation of EGFR signaling and thus as a potential target for inhibiting EGFR‐mediated tumor progression.     

Neck observation versus elective neck dissection in management of clinical T1/2NO oral squamous cell carcinoma: a retrospective study of 232 patients

Objective:The management of early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC) remains a controversial issue.The aim of this study was to compare the clinical outcomes of neck observation (OBS) and elective neck dissection (END) in treating patients with cT1/2N0OSCC.Methods:A total of 232 patients with cT1/2N0OSCC were included in this retrospective study.Of these patients,181 were treated with END and 51 with OBS.The survival curves of 5-year overall survival (OS),diseasespecific survival (DSS),and recurrence-free survival (RFS) rates were plotted using the Kaplan-Meier method for each group,and compared using the Log-rank test.Results:There was no significant difference in 5-year OS and DSS rates between END and OBS groups (OS:89.0％ vs.88.2％,P=0.906;DSS:92.3％ vs.92.2％,P=0.998).However,the END group had a higher 5-year RFS rate than the OBS group (90.1％ vs.76.5％,P=0.009).Patients with occult metastases in OBS group (7/51) had similar 5-year OS rate (57.1％ vs.64.1％,P=0.839) and DSS rate (71.4％ vs.74.4％,P=0.982) to those in END group (39/181).In the regional recurrence patients,the 5-year O S rate (57.1％ vs.11.1％,P=0.011) and D SS rate (71.4％ vs.22.2％,P=0.022) in OBS group (7/51) were higher than those in END group (9/181).Conclusions:The results indicated that OBS policy could obtain the same 5-year OS and DSS as END.Under close follow-up,OBS policy may be an available treatment option for patients with clinical T1/2N0OSCC.     

声门上癌颈淋巴结转移的外科治疗

目的: 探讨声门上癌颈淋巴结转移的特点及颈清术在声门上癌外科治疗中的应用 方法: 分析210例声门上癌的颈淋巴结转移情况. 结果: 颈淋巴结转移率为47.6%,隐匿转移率为32.4%;行颈清术420例次,转移淋巴结535枚;不同肿瘤部位的转移率为:会厌室带51.9%,会厌33.3%,室带40.7%,杓会厌襞77.8%;不同肿瘤大小的转移率为:T1 14.7%,T2 37.7%,T3 53.4%,T4 77.6%;不同肿瘤分化程度的淋巴结转移率:G1 12.9%,G2 41.0%,G3 91.1% 结论: 声门上癌的颈淋巴结转移与肿瘤的部位、大小(T)、分化程度(G)密切相关,转移淋巴结主要位于Ⅱ、Ⅲ区,Ⅱ区淋巴结应为前哨淋巴结,对临床N+病例应行根治性颈清术,对G3、T3和T4、杓会厌襞癌或累及杓会厌襞的声门上癌的临床N0病例应行肩胛舌骨肌上颈清术.     

Long-term results of the combined modality therapy for advanced cervical metastatic head and neck squamous cell carcinoma.

AIM: A consensus treatment strategy for advanced cervical metastatic head and neck squamous cell carcinoma has not been established. The aim of this retrospective study was to investigate the outcome of these patients uniformely using a strategy which consists of surgery for the primary tumor and the neck metastases followed by postoperative radio(chemo)therapy. METHODS: We included a selected series of 518 patients with previously untreated head and neck squamous cell carcinoma. The overall survival (OS), the disease specific survival (DSS), the disease free survival (DFS), the local control (LC) and regional control (RC) estimates were calculated. The statistical relationship of various clinical and histopathological variables on the above mentioned estimates were analyzed. RESULTS: The overall survival probability was 73.2% for pN0 stage, 43% for pN>1 stages and 31% for pN2c/pN3 stages. The pN stage significantly influenced the survival probabilities in oropharyngeal (p=0.0001) and laryngeal tumors (p<0.0001) in univariate analyses. In multivariate analysis, age, pT stage, pN stage, M stage, and extranodal spreading were independent risk factors for decreased disease-specific survival. CONCLUSIONS: We could show that pN stage is an important independent prognostic factor in head and neck cancer. The presented multimodal treatment protocol provides excellent oncological outcomes and should therefore be standard of care for patients with operable advanced cervical metastatic head and neck squamous cell carcinoma.     

甲状腺癌纵隔淋巴结转移的外科处理

目的评价甲状腺癌上纵隔淋巴清扫的意义。方法回顾性分析1984年至1998年期间,我科收治的79例甲状腺癌上纵隔淋巴清扫患者的临床资料。58例（73．4％）为乳头状甲状腺癌,14例（17．7％）为甲状腺髓样癌,7例（8．9％）为滤泡状甲状腺癌。随诊终止日期为2003年12月。结果经颈上纵隔淋巴清扫62例,胸骨部分劈开上纵隔淋巴清扫10例,全胸骨劈开上纵隔淋巴清扫7例。79例中,3例患者仅行上纵隔清扫,未做颈清扫;76例患者中完成93个颈清扫,47例发生气管旁淋巴结转移。总的5年和10年累积生存率分别为64．6％和63．1％。10例发生上纵隔淋巴结复发,9例死于上纵隔病变,11例发生术后并发症。结论在甲状腺癌上纵隔淋巴结转移的患者中,乳头状甲状腺癌最常见。上纵隔淋巴清扫安全有效,可以改善患者的生活质量,延长患者的生存时间。     

胸段食管鳞癌颈部淋巴结转移特点及其临床意义

背景与目的：食管癌颈部淋巴结转移率较高,但少有专门报道。本研究分析胸段食管鳞癌颈部淋巴结转移特点,探讨其临床意义。方法：选择1993年1月—2003年12月在福建省肿瘤医院行胸段食管鳞癌三野淋巴结清扫根治术患者1 131例,对术后病理证实颈部淋巴结转移患者376例的具体情况进行分析。结果：全组颈部淋巴结转移率为33.2%,其中胸上、中及下段的颈部淋巴结转移率分别为43.7%、33.0%和16.0%。单因素分析显示,颈部淋巴结转移率与肿瘤部位、病理分化程度、病变X线长度、pT分期以及淋巴结转移个数有关(P<0.05),但多因素回归分析显示,颈部淋巴结转移率只与肿瘤部位、pT分期及淋巴结转移个数有关(P<0.05)。颈段食管旁淋巴结转移最多见,其次是锁骨上淋巴结转移,颈深淋巴结及咽后淋巴结转移少见;胸上、中及下段的颈部淋巴结转移数占该段淋巴结总转移数的比率分别为57.7%、32.0%和10.0%,差异有统计学意义(P<0.05);各段食管癌右颈部淋巴结转移多于左颈部。结论：影响胸段食管鳞癌颈部淋巴结转移独立因素是肿瘤部位、pT分期及淋巴结转移数;颈段食管旁淋巴结转移最多见,其次是锁骨上淋巴结转移,颈深淋巴结及咽后淋巴结转移少见。