头颈部鳞状细胞癌远处转移的相关因素分析

目的探讨头颈肿瘤远处转移的相关影响因素。方法对532例头颈部原发鳞状细胞癌患者的临床病理资料进行回顾性分析。选择性别、年龄、临床分期、T分级、N分级、原发癌部位、原发癌浸润深度、原发癌病理分级、有无颈淋巴结转移、颈阳性淋巴结数目、颈淋巴结转移累及区域、颈阳性淋巴结破膜情况等临床病理因素，用)(2检验和Logistic回归进行单因素和多因素分析，并用．Kaplan-Meier法对发生远隔部位转移患者进行生存分析。结果在532例头颈部原发鳞状细胞癌患者中，60例(11．3％)发生远处转移。单因素分析显示，临床分期(P=0．0126)、T分级(P=0．0082)、原发癌部位(P=0．0011)、原发癌浸润深度(P=0，0005)、有无颈淋巴结转移(P=0．0057)、颈阳性淋巴结数目(P=0．0149)、颈淋巴结转移累及区域(P=0．0034)、颈阳性淋巴结破膜情况(P=0．0118)与发生远处转移有关。多因素分析结果表明，仅原发癌部位、原发癌浸润深度与发生远处转移明显相关。用Kaplan-Meier法进行生存分析，结果显示60例发生远隔部位转移患者的1年生存率、3年生存率、5年生存率分别为51．7％、13．3％、6．5％。结论原发肿瘤部位和浸润深度是发生远处转移的共同决定性因素。而原发癌临床分期、T分级和有无颈淋巴结转移是头颈鳞癌远处转移的影响因素，但不是导致远处转移的初始和根本因素。喉癌、下咽癌以及原发癌侵犯肌肉、骨或软骨患者易发生远处转移。     

头颈部鳞状细胞癌远处转移的相关因素分析

目的探讨头颈肿瘤远处转移的相关影响因素.方法对532例头颈部原发鳞状细胞癌患者的临床病理资料进行回顾性分析.选择性别、年龄、临床分期、T分级、N分级、原发癌部位、原发癌浸润深度、原发癌病理分级、有无颈淋巴结转移、颈阳性淋巴结数目、颈淋巴结转移累及区域、颈阳性淋巴结破膜情况等临床病理因素,用χ2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对发生远隔部位转移患者进行生存分析.结果在532例头颈部原发鳞状细胞癌患者中,60例(11.3%)发生远处转移.单因素分析显示,临床分期(P=0.0126)、T分级(P=0.0082)、原发癌部位(P=0.0011)、原发癌浸润深度(P=0.0005)、有无颈淋巴结转移(P=0.0057)、颈阳性淋巴结数目(P=0.0149)、颈淋巴结转移累及区域(P=0.0034)、颈阳性淋巴结破膜情况(P=0.0118)与发生远处转移有关.多因素分析结果表明,仅原发癌部位、原发癌浸润深度与发生远处转移明显相关.用Kaplan-Meier法进行生存分析,结果显示60例发生远隔部位转移患者的1年生存率、3年生存率、5年生存率分别为51.7%、13.3%、6.5%.结论原发肿瘤部位和浸润深度是发生远处转移的共同决定性因素.而原发癌临床分期、T分级和有无颈淋巴结转移是头颈鳞癌远处转移的影响因素,但不是导致远处转移的初始和根本因素.喉癌、下咽癌以及原发癌侵犯肌肉、骨或软骨患者易发生远处转移.     

颈淋巴结连续切片cytokeratin免疫组化染色法在诊断头颈部癌微灶转移的应用

目的：研究一种检测头中恶性肿瘤微灶转移的方法。方法：对51例临床诊断颈淋巴结阴性（cN0)的头颈部恶性肿瘤病人颈廓清标本同时用常规病理切片和连续切片免疫组化染色（抗细胞角蛋白，cytokeratin,CK)比较其微灶转移检查结果，进行统计学分析。结果：常规病理切片其颈淋巴结病理阳性（pN^ )为29．41％；而连续切片抗CK阳性率为49．02％，二者卡方检验有显著性差异（P＜0．05）。发现51例cN0病人中，常规病理检查有36例为pN。经组化CK染色这36例中又有10例被证实为颈淋巴微灶转移（27．78％）。结论：对于头颈肿瘤的颈淋巴隐匿性病理转移的诊断，应用连续切片的免疫组化染色法有一定优势，是一种检测微灶转移较为敏感的方法。     

头颈鳞状细胞癌干细胞研究进展

头颈鳞状细胞癌容易发生局部复发、颈淋巴结转移以及远处转移,预后差。肿瘤干细胞在肿瘤转移中具有重要意义,而肿瘤干细胞标记物是分离鉴定肿瘤干细胞的重要物质基础。循环肿瘤细胞是肿瘤细胞从原发灶脱落入外周血中继而形成转移灶的一类细胞,其中部分具有干细胞特性,其与肿瘤的转移、临床特征、预后密切相关。本文就与头颈鳞状细胞癌相关的肿瘤干细胞研究进展做一综述。     

头颈部鳞癌端粒酶活性的定量检测

目的：了解头颈部鳞癌及其颈淋巴结转移癌端粒酶的表达情况,探讨粒酶活性定量分析在头颈鳞癌诊断中的价值。方法：采用端粒重复序列液体闪烁计数法检测端粒酶活性。共检测取自２５例头颈部鳞癌患者的组织样本５５份,其中７例患者同时取有原发癌及其颈淋巴结转移癌两份样本,以２３份正常组织为对照。结果：①３２份原发鳞癌组织中端粒酶活性（ｃｐｍ值）在１０００以上的２８份,除２份外,均明显高于正常组织;２３份正常组织的端     

免疫组化和连续切片在检测头颈鳞癌颈淋巴结微转移中的意义

目的〓〖HTK〗探讨应用连续切片EnvisionTM法检测角蛋白表达对判断头颈鳞状细胞癌淋巴结微转移的效果及微转移对肿瘤预后的影响。〖HTW〗方法〓〖HTK〗术中淋巴结标本行快速EnvisionTM法检测角蛋白CKAE1/AE3,与常规冰冻病理对淋巴结微转移检出率比较。对14例下咽癌、声门上型喉癌淋巴结标本连续病理切片,比较常规病理检测与EnvisionTM法对淋巴结微转移检出率。〖HTW〗结果〓〖HTK〗快速EnvisionTM法可检出2粒常规冰冻病理不能检出的淋巴结微转移,连续切片应用EnvisionTM法可检出5粒常规病理阴性的淋巴结（5/216）存在微转移灶。〖HTW〗结论〓〖HTK〗EnvisionTM法检测角蛋白CKAE1/AE3表达可快速判断头颈部鳞状细胞癌淋巴结微转移,存在多粒淋巴结微转移的患者预后可能较差。     

颈淋巴结连续切片cytokeratin免疫组化染色法在诊断头颈部癌微灶转移的应用

目的 :研究一种检测头颈部恶性肿瘤微灶转移的方法。方法 :对 5 1例临床诊断颈淋巴结阴性 (c N0 )的头颈部恶性肿瘤病人颈廓清标本同时用常规病理切片和连续切片免疫组化染色 (抗细胞角蛋白 ,cytokeratin,CK)比较其微灶转移检查结果 ,进行统计学分析。结果 :常规病理切片其颈淋巴结病理阳性 (p N+ )为 2 9.4 1% ;而连续切片抗 CK阳性率为4 9.0 2 % ,二者卡方检验有显著性差异 (P <0 .0 5 )。发现 5 1例 c N0 病人中 ,常规病理检查有 36例为 p N0 ,经组化 CK染色这 36例中又有 10例被证实为颈淋巴微灶转移 (2 7.78% )。结论 :对于头颈肿瘤的颈淋巴隐匿性病理转移的诊断 ,应用连续切片的免疫组化染色法有一定优势 ,是一种检测微灶转移较为敏感的方法。     

头颈部鳞癌颈淋巴结隐匿性转移

目的探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法对111例头颈部鳞癌N0M0患者的颈淋巴结清扫标本进行切片观察。结果隐匿性转移总体发生率为26．12％(29／111)。其中口腔癌18．75％(15／80)，口咽癌25．00％(1／4)，下咽癌54．54％(6／11)，喉癌43．75％(7／16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N0M0患者5年生存率为66．7％，其中pN^-为74．39％(61／82)，pN^ 为44．82％(13／29)。结论对临床T3和T4期、癌组织分化程度低和深度浸润的cN0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

头颈鳞癌和颈清扫淋巴结D9S171位点杂合性缺失的研究

目的探讨头颈鳞状细胞癌在D9S171微卫星多态性位点的杂合性缺失(Loss of heterozygosity,LOH)的发生率、临床意义及对检测颈淋巴结转移的应用价值.方法标准酚氯仿法提取肿瘤组织及颈清扫淋巴结组织的基因组DNA,采用D9S171微卫星多态性位点进行聚合酶链反应(Polymerase cham reaction,PCR)扩增、变性聚丙烯酰胺凝胶电泳、硝酸银染色.分析D9S171微卫星多态性位点的LOH.结果头颈鳞癌原发癌组织的D9S171多态性位点的LOH发生率为62.96%;LOH发生与患者的临床分期有相关关系(P＜0.01).颈清扫淋巴结组织D9S171多态性位点的LOH发生率(35.60%),高于常规病检的阳性率(17.0%),(P＜0.01).结论D9S171多态性位点LOH与头颈鳞癌的发生有密切关系,LOH分析可能作为检测头颈鳞癌颈淋巴结转移的手段之一.     

头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

Histopathological features of occult metastasis detected by sentinel lymph node biopsy in oral and oropharyngeal squamous cell carcinoma.

OBJECTIVES: Sentinel lymph node biopsy has been introduced for head and neck cancer with promising results. Research in breast cancer has revealed different histopathological features of occult lymph node metastasis with possibly different clinical and prognostic implications. The aim of the study was to evaluate the histopathological features of occult metastasis detected by sentinel lymph node in oral and oropharyngeal squamous cell carcinoma. STUDY DESIGN: Prospective. METHODS: According to Hermanek (5), occult metastasis was differentiated into isolated tumor cells and infiltration of lymph node parenchyma smaller than 2 mm in diameter (micrometastasis) and larger than 2 mm in diameter (metastasis). RESULTS: Occult metastases were found in 6 of 19 (32%) sentinel lymph nodes. Three patients showed micrometastasis with a mean size of 1.4 mm (range, 1.2-1.5 mm), the first with three separate micrometastases within the same sentinel lymph node, the second with an additional cluster of isolated tumor cells within the same sentinel lymph node, and the third with an additional micrometastasis in one lymph node of the elective neck dissection. Two patients had macrometastasis (3.4 and 8 mm), both with multiple metastases in the elective neck dissection. One patient had two clusters of isolated tumor cells in the sentinel lymph node and an additional cluster of isolated tumor cells in one lymph node of the elective neck dissection. CONCLUSIONS: Occult metastasis can be subdivided histopathologically in isolated tumor cells, micrometastasis, and macrometastasis. We present the first study describing a great variety of these subtypes in sentinel lymph nodes from head and neck squamous cell carcinoma. Because the independent prognostic factor and clinical relevance of these subtypes is still unclear, we emphasize the importance of reporting these findings uniformly and according to well-established criteria.     

Head and neck metastases from occult abdominal primary site: a case report and literature review

OBJECTIVES: A very rare case of cervical lymph node metastasis from the liver is reported. The clinical findings and the diagnosis of a metastasis to the head and neck from the isolated silent abdominal cancer are discussed. MATERIAL AND METHODS: The clinical and histopathological findings of a 56-year-old woman with a metastatic cervical lymph node of unknown origin are presented, together with a literature review of metastases from an occult abdominal primary. RESULTS: The primary site was identified as an undifferentiated cholangiolocellular carcinoma using immunostaining for anti-cytokeratin subclasses after autopsy. Fifty-two cases of head and neck metastases from an abdominal primary cancer were found and separately summarized according to the metastatic routes. CONCLUSIONS: When a metastatic neck cancer of unknown origin is diagnosed, it is very important to consider the possibility of a metastasis from an abdominal organ. Recognition of metastatic routes and their characteristics is helpful in the search for the occult abdominal primary site. Immunohistochemistry of the metastatic cancer may provide important information for identifying the primary site in cases of metastasis of an undifferentiated carcinoma.     

Occult Cervical Metastasis in Head and Neck Cancer and its Impact on Therapy

Objectives A very rare case of cervical lymph node metastasis from the liver is reported. The clinical findings and the diagnosis of a metastasis to the head and neck from the isolated silent abdominal cancer are discussed.

Material and Methods The clinical and histopathological findings of a 56-year-old woman with a metastatic cervical lymph node of unknown origin are presented, together with a literature review of metastases from an occult abdominal primary.

Results The primary site was identified as an undifferentiated cholangiolocellular carcinoma using immunostaining for anti-cytokeratin subclasses after autopsy. Fifty-two cases of head and neck metastases from an abdominal primary cancer were found and separately summarized according to the metastatic routes.

Conclusions When a metastatic neck cancer of unknown origin is diagnosed, it is very important to consider the possibility of a metastasis from an abdominal organ. Recognition of metastatic routes and their characteristics is helpful in the search for the occult abdominal primary site. Immunohistochemistry of the metastatic cancer may provide important information for identifying the primary site in cases of metastasis of an undifferentiated carcinoma.     

喉癌颈部淋巴结微转移与早期复发及预后关系探讨

目的分析pN0喉鳞状细胞癌患者颈部淋巴结微转移与早期复发和预后的相关性。方法收集本院2005年7月～2009年4月诊治的喉鳞状细胞癌患者中行颈廓清术后经常规病理学HE染色切片检查pN0癌病例31例的临床及病理资料;石蜡包埋的颈廓清术淋巴结标本行半连续切片HE染色,经多名有经验的病理科医师重新阅片,证实有无微转移灶。采用χ2检验分析微转移与早期复发的相关性,Kaplan-Meier曲线用于描述有无微转移两组患者的无瘤生存(disease-free survival)曲线分布。结果全部31例418枚淋巴结蜡块标本中发现微转移8例,除年龄、分化程度外的各临床病理因素与微转移之间均无相关性,微转移与早期复发之间无相关性(P>0.05)。Kaplan-Meier曲线用于描述有、无微转移两组患者的无瘤生存(disease-free survival)曲线分布,两组患者的无瘤生存率无明显分离趋势(P>0.05)。结论本研究表明pN0喉鳞型细胞癌患者中,颈淋巴结中微转移灶的存在与复发和预后无关。     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的　评价前哨淋巴结 (sentinellymphnode ,SLN)检测在N0头颈鳞状细胞癌 (简称鳞癌 )中的可行性以及SLN对微小转移灶的诊断价值。方法　分析研究中国医学科学院肿瘤医院头颈外科 2 0 0 1年 8月～ 2 0 0 2年 2月收治的 10例头颈鳞癌患者 ,为未经治疗临床诊断为N0的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体 (technetium 99m preparedwithdextrancolloid ,99mTc DX) ,约 30min后行单光子发射计算机断层显像术扫描 ,在相应的颈部皮肤上标记显像“热点” ;术中翻开皮瓣后用手提探测仪探测术野 ,以高于背景计数 4倍以上确定为SLN。将确定的SLN送病理学检查 ,并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果　术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查 ,10例N0患者有 3例发现隐性转移 ,其隐性转移率为 30 % (3/ 10 ) ,SLN的阳性率为 2 2 .7% (5 / 2 2 ) ,非SLN的阳性率为 0 .4 % (1/ 2 4 7)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论　头颈鳞癌颈部N0的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围 ,减少手术的创伤及并发症 ,该技术的进一步推广还需更多的研究。     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的 评价前哨淋巴结(sentinel lymph node，SLN)检测在NO头颈鳞状细胞癌(简称鳞癌)中的可行性以及SLN对微小转移灶的诊断价值。方法 分析研究中国医学科学院肿瘤医院头颈外科2001年8月～2002年2月收治的10例头颈鳞癌患者，为未经治疗临床诊断为NO的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体(technetium 99m prepared with dextran colloid，^99mTc-DX)，约30min后行单光子发射计算机断层显像术扫描，在相应的颈部皮肤上标记显像“热点”；术中翻开皮瓣后用手提探测仪探测术野，以高于背景计数4倍以上确定为SLN。将确定的SLN送病理学检查，并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查，10例NO患者有3例发现隐性转移，其隐性转移率为30％(3／10)，SLN的阳性率为22．7％(5／22)，非SLN的阳性率为0．4％(1／247)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论 头颈鳞癌颈部NO的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围，减少手术的创伤及并发症，该技术的进一步推广还需更多的研究。     

CT诊断头颈癌颈淋巴结转移的病理学基础

为研究ＣＴ诊断颈淋巴结转移的病理科基础，应用双盲法对行颈廓清术的２２例（２６侧）头颈癌患者术前的触诊、病理学、ＣＴ扫描特征的相关性进行对比研究。资料显示：２６例中，１６例ＣＴ扫描阳性，其中１例为假阳性，１０侧阴性，其中１侧为假阴性。ＣＴ扫描的敏感性、特异性、准确率分别为９３．８％、９０．０％、９２．３％。并就头颈部鳞癌转移淋巴结ＣＴ影像的诊断标准和相应的病理学特征，以误诊、漏诊的原因进行讨论。     

Neck dissection: past, present and future?

With the exception of distant metastasis, the presence of cervical lymph node metastasis is the single most adverse independent prognostic factor in head and neck squamous cell carcinoma. Surgical removal of metastatic cervical lymph nodes had been attempted during the late nineteenth century, with varying techniques and poor results. A systematic approach to en bloc removal of cervical lymph node disease, described in detail by Jawdyński at the end of the nineteenth century and popularized and illustrated by Crile in the early twentieth century, provided consistent and more effective treatment and forms the basis of our current techniques. The concepts of radical neck dissection, employed extensively by Martin, were followed with almost religious consistency by most head and neck surgeons until the late twentieth century, when the principles of 'functional' neck dissection, developed by Suárez and popularized by Bocca, Gavilán, Ballantyne, Byers and others, led to the acceptance of modified radical neck dissection as treatment for lymph node disease in various stages. More recently, selective neck dissection, involving removal of nodes confined to the levels at greatest risk of metastasis from primary tumours at various sites, has become accepted practice for elective and, in some instances, therapeutic treatment of the neck. In the future, sentinel lymph node biopsy and the use of molecular pathological analyses may be employed to predict the presence of occult cervical disease, thus directing therapy to patients at greatest risk and sparing those without regional metastasis.     

Sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma

The appearance of lymph node metastases represents the most important adverse prognostic factor in head and neck squamous cell carcinoma. Therefore, accurate staging of the cervical nodes is crucial in these patients. The management of the clinically and radiologically negative neck in patients with early oral and oropharyngeal squamous cell carcinoma is still controversial, though most centers favor elective neck dissection for staging of the neck and removal of occult disease. As only approximately 30% of patients harbor occult disease in the neck, most of the patients have to undergo elective neck dissection with no benefit. The sentinel node biopsy concept has been adopted from the treatment of melanoma and breast cancer to early oral and oropharyngeal squamous cell carcinoma during the last decade with great success. Multiple validation studies in the context of elective neck dissections revealed sentinel node detection rates above 95% and negative predictive values for negative sentinel nodes of 95%. Sentinel node biopsy has proven its ability to select patients with occult lymphatic disease for elective neck dissection, and to spare the costs and morbidity to patients with negative necks. Many centers meanwhile have abandoned routine elective neck dissection and entered in observational trials. These trials so far were able to confirm the high accuracy of the validation trials with less than 5% of the patients with negative sentinel nodes developing lymph node metastases during observation. In conclusion, sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma can be considered as safe and accurate, with success rates in controlling the neck comparable to elective neck dissection. This concept has the potential to become the new standard of care in the near future.