下咽癌颈淋巴结转移的临床病理学特点及其对预后的影响

目的　探讨影响下咽癌颈淋巴结转移的临床病理因素和颈淋巴结转移对预后的影响。方法　采用 χ2 检验和Logistic回归分析 ,对 98例下咽癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究。并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域等淋巴结病理学因素对生存率的影响 ,进行Cox回归分析。结果　下咽癌患者 5年生存率为 2 8 6 %。单因素和多因素分析均证实 ,肿瘤生长方式、肿瘤大小与发生颈淋巴结转移关系密切。而肿瘤突破基底膜达黏膜下层后对下咽癌颈淋巴结转移发生率不再产生进一步影响。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、转移颈淋巴结最低受累区域因素影响患者生存率 ,特别是转移颈淋巴结大小、转移颈淋巴结最低受累区域因素与下咽癌患者生存率明显相关。结论　下咽癌颈淋巴结转移是影响患者预后的重要因素 ,预测下咽癌颈淋巴结 ,对其作出早期正确诊断 ,并对影响预后的淋巴结因素采取相应治疗措施是提高下咽癌治疗效果的关键。     

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。     

头颈部鳞癌颈淋巴结转移诸因素对预后的影响

对382例头颈部原发鳞癌病人颈清扫标本连续切片病理观察结果和临床资料进行回顾性分析，探讨淋巴结转移的各项临床和病理学因素与病人预后的关系。发现总体5年生存率为46.1％，口腔癌、口咽癌、下咽癌和喉癌的5年生存率分别为49．7％，39．7％，35．0％和60．3％。表明颈淋巴结的临床分期、触诊淋巴结大小、病理转移淋巴结情况、颈淋巴解剖分区受累数和最低受累平面与病人5年生存率有密切关系（均P＜0．01），而阳性淋巴的个数对病人预后无明显影响。提示针对影响预后的淋巴结因素应采取相应的治疗措施，以提高病人的5年生存率。     

97例下咽癌临床特点分析

目的:总结分析下咽癌的临床特征、治疗效果及预后影响因素。方法:回顾性分析2008-01-2012-12期间我院耳鼻咽喉科收治的下咽癌97例患者临床病例资料;梨状窝型75例,咽后壁型16例,环后型6例。手术方式包括下咽部分切除术21例(21.6%),部分喉切除加下咽部分切除7例(7.2%),全喉加下咽部分切除术53例(54.6%),全喉全下咽切除加胃上提胃咽吻合术12例(12.4%),全喉全下咽切除加空肠代食道修补术4例(4.1%)。61例术后于肿瘤科进行放疗。采用χ2检验行计数资料分析,采用寿命表法计算生存率,采用KaplanMeier法进行生存分析,并行Log-rank检验。采用Cox回归模型对影响患者预后因素行多因素分析。结果:本组患者随访率为90.7%。全部患者1年生存率为76.0%,3年生存率为56.0%,术后病理颈部淋巴结转移率为71.1%,隐匿性淋巴结转移占19.6%。术后局部复发率为21.6%。患者死亡的主要原因包括:颈部淋巴结转移7例(21.9%),局部复发12例(37.5%),远处转移10例(31.3%)等。单因素分析显示肿瘤的大小(P<0.01)以及肿瘤的T分期(P<0.05)对生存预后有影响,Cox回归模型多因素分析未发现影响患者预后的独立危险因素。结论:下咽癌早期不易发现,术后极易发生复发及转移,慎重选择病灶切除术式及颈清扫方式,辅助术后放射治疗是主要的治疗策略。咽后壁型下咽癌较另外两型下咽癌更易出现术后的复发及转移,治疗创伤较大,应引起重视。     

下咽癌颈淋巴转移相关因素的研究

目的研究下咽癌颈淋巴转移的特点、规律及对预后的影响。方法收集1985-2000年住院治疗下咽癌患者108例，均经手术治疗，且术前未行放疗和化疗。根据1992年国际抗癌联合会（UICC）分期标准进行分期分级。手术后将下咽癌及颈淋巴结标本进行病理观察，确定肿瘤主体所在原发部位及发生转移的颈淋巴结分布区域。按照病理学将肿瘤的病理分化程度确定为高、中、低分化。通过颈淋巴结病理检查和随访观察确定颈淋巴转移情况，用Kaplan-Meier方法对3、5年生存率进行非参数分析。结果病例中T1、T2淋巴结转移率为45．8％，T3、T4淋巴结转移率为79．8％，总的淋巴结转移率为75．0％（81／108），（P〈0．05）。梨状窝癌为100例，占全部病例的92．6％（100／108），梨状窝及下咽后壁癌的颈淋巴转移率分别为74．0％和87．5％（P〉0．05）。病理高、中、低分化型3组，其颈淋巴转移率分别为72．2％、67．6％、85．7％（P〉0．05）。患者3、5年累积生存率分为67．53％及29．87％。Ⅱ、Ⅲ区颈淋巴转移率为76．5％，Ⅴ、Ⅵ区颈淋巴转移率为8．6％。结论下咽癌颈淋巴转移率高。下咽癌颈淋巴转移是影响下咽癌的预后主要因素，随着颈淋巴转移程度的增加，患者3、5年生存率逐渐降低。     

下咽癌颈淋巴结转移区域探讨

目的 研究下咽癌颈淋巴结转移区域的特点及术后治疗策略,改善预后.方法 回顾性分析2002年7月～2008年7月于我科住院治疗的35例下咽癌患者的临床资料,29例患者均行手术治疗,且术前未行放疗或化疗,将术中肿瘤原发灶及颈清扫术中的颈淋巴结标本按区域标记逐一进行病理观察,确定肿瘤原发部位及颈淋巴结转移区域.通过随访3～5年,观察转移及预后.结果 29例下咽癌总的颈淋巴结转移率为86.2％(25/29),颈淋巴结转移的主要区域为Level Ⅱ区、Level Ⅲ区,转移率为73.8％、69.0％,其次为Level Ⅳ区7.7％,未发现Level Ⅰ区、Level Ⅴ及LevelⅥ区淋巴结转移.结论 下咽癌颈淋巴结转移率较高,转移区域同侧为主,以Level Ⅱ、Level Ⅲ区常见.随着颈淋巴结位置的下移及转移淋巴结直径的增大,患者的预后越来越差.     

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.     

颈部淋巴结阴性下咽癌患者的预后及远期生存分析[论著]

目的　研究分析淋巴结病理阴性（pN0）下咽鳞状细胞癌患者的生存和预后影响因素。方法　回顾性分析2001年1月~2014年12月在复旦大学附属眼耳鼻喉科医院行下咽切除术的53例下咽鳞状细胞癌患者资料,所有患者经术前评估均无颈部淋巴结转移,均行颈清扫术并且病理证实无颈部淋巴结转移。收集患者临床病理资料,随访其生存情况并分析预后影响因素。结果　梨状窝癌37例,环后区癌7例,咽后壁癌9例。T1级2例,T2级21例,T3级21例,T4级9例。5年无病生存率、疾病特异性生存率、总生存率分别为61.1%、63.6%、42.4%。多因素分析显示食管侵犯是影响复发率、疾病特异性生存率、总生存率的独立危险因素。结论  食管侵犯是颈部淋巴结阴性下咽鳞状细胞癌患者的重要预后影响因素,对于食管发生侵犯的患者术后应密切随访。     

下咽癌的淋巴结转移

淋巴结转移已经成为影响下咽癌预后的主要因素。本文从颈深淋巴结转移、咽后淋巴结转移、气管旁淋巴结转移三个部分，综述了下咽癌淋巴结转移的转移方式、处理方法和对预后的影响。     

喉癌和下咽癌颈淋巴结转移临床对比分析

目的：探讨喉癌、下咽癌患者颈淋巴结转移的特点和分布规律。方法：对全喉切除术同期及复发后第1次行颈淋巴结清扫的129例喉癌、下咽癌患者的临床资料进行回顾性对比分析，研究不同类型的喉癌、下咽癌患者颈淋巴结的转移情况。结果：声门上型喉癌、下咽癌患者易发生早期淋巴结转移；下咽癌患者的转移淋巴结融合率高，颈静脉下区出现阳性淋巴结的比率高；声门上型喉癌、下咽癌患者原发病灶分化差的比率相对偏高；同期与复发后行颈淋巴结清扫的患者原发病灶分期差异无显著性意义。结论：对T2期及以上的声门上型喉癌及下咽癌患者，尤其当细胞分化比较差时，即使颈淋巴结阳性体征不明显亦应积极考虑颈淋巴结清扫问题，对下咽癌患者行颈淋巴结清扫时应考虑彻底清扫颈静脉下区的淋巴结。     

择区性颈清扫术治疗63例下咽鳞状细胞癌的颈淋巴转移

目的 分析下咽鳞状细胞癌(简称鳞癌)患者颈部淋巴转移规律,评价择区性颈清扫术(selective neck dissection,SND)在下咽癌颈淋巴转移治疗中的效果.方法 回顾性分析1990年1月至2004年12月在北京大学第一医院接受颈清扫术的下咽鳞癌患者63例,其中cN0患者17例,cN+46例.单侧SND共计15例;双侧SND共计22例;改良性颈清扫术(modified radical neck dissections,MRND)共计16例;一侧行经典性颈清扫术(radical neck dissections,RND)或MRND,另一侧行SND共计10例.随访48例(76.2%),随访时间范围为24～143个月,随访中位时间为41个月.结果 颈清扫术后发现淋巴结病理阴性(pN0)22例,淋巴结病理阳性(pN+)41例.95侧清扫标本中共发现106枚阳性淋巴结,其在颈部的分布如下:Ⅰ区0%,Ⅱ区47.2%(50/106),Ⅲ区33.0%(35/106),Ⅳ区11.3%(12/106),Ⅴ区2.8%(3/106),Ⅵ区5.7%(6/106).值得注意的是,无论是cNO还是cN+下咽癌患者,对侧颈部都可出现淋巴转移和复发.在随访的48例中,共有18例(21例次)复发.颈清扫术后淋巴结复发主要分布在Ⅱ区和Ⅲ区(19例次).根据Kaplan-Meier方法计算3年生存率,pN0患者为58.1%,pN1患者为44.9%,pN2患者为41.1%.Cox同归分析:N分级是影响预后最重要的因素,pN1的危险比为1.7,pN2的危险比为2.2.结论 淋巴转移是下咽鳞癌最重要的预后因素.恰当的选择双侧SND,可以取得较满意效果,同时减少患者形态和功能的损伤.     

Telomerase catalytic subunit gene expression does not influence survival of patients with squamous cell carcinoma of the larynx and hypopharynx: a case-control study

AIMS: to determine correlations between relative quantities of telomerase catalytic subunit m-ribonucleic acid (hTERT mRNA) and conventional clinicopathological parameters (such as site, size and grade of tumour, the presence of regional lymph node metastases, and, in particular, survival) in patients with laryngeal and hypopharyngeal squamous cell carcinomas (SCCs). MATERIAL AND METHODS: The relative quantity of hTERT mRNA was analysed by a commercially available LightCycler Telo TAGGG hTERT Quantification Kit in 56 cases of SCC (40 laryngeal and 16 hypopharyngeal). The association with cancer-specific survival was evaluated by univariate and multivariate analysis. RESULTS: Location of the tumour in the hypopharynx was the only significant negative predictive factor for survival, as determined by univariate analysis (p = 0.028). Although a tendency towards a better overall survival was observed for female patients younger than 50 years, for lower tumour grades and sizes, and for the absence of regional lymph node metastases, the prognostic significance of these factors could not be confirmed. No differences existed in hTERT mRNA expression between laryngeal and hypopharyngeal SCCs. Furthermore, no correlation was found between the relative quantities of hTERT mRNA and the tumour size, regional lymph node metastases or survival of patients with laryngeal or hypopharyngeal SCCs. CONCLUSIONS: The results of the present study suggest that genetic abnormalities other than telomerase reactivation are responsible for progression of laryngeal and hypopharyngeal SCCs.     

Usefulness and limitations in ultrasonography for diagnosing neck lymph node metastases in patients with hypopharyngeal squamous cell carcinoma: comparison with pathological findings following neck dissection

We evaluated the usefulness and limitations in ultrasonography (US) for diagnosing neck lymph node metastases in patients with hypopharyngeal cancer by comparing the results of preoperative US examinations with postoperative pathological findings following neck dissection. Seventy-five previously untreated patients with hypopharyngeal squamous cell carcinoma underwent a curative procedure that included neck dissection. Preoperatively, all patients were examined by palpation, computed tomography (CT), and US. Postoperatively, all dissected neck lymph nodes were submitted for pathological examination. Results of pre-and postoperative examinations were then compared. US accuracy for each lymph node was 93.9%, while sensitivity was 78.0%, since hypopharyngeal cancer metastasizes early and easily to the neck lymph nodes, and it is difficult to detect small, pathologically positive nodes. Nine of 75 cases showed latent neck recurrence, and two of these were underestimated by US. The major cause for neck recurrence was considered to be the high rate of metastases in such cases, rather than a reduced dissection field. It is not rare to find very small, pathologically positive lymph nodes that US cannot detect in hypopharyngeal cancer. Efforts must therefore be expanded to improve the accuracy of US diagnosis. Care must also be taken when selecting cases for no or limited neck dissection.     

Predictive value of lymph node metastases and extracapsular extension for the risk of distant metastases in laryngeal carcinoma

OBJECTIVE: The objective of this retrospective chart analysis was to determine the prognostic value of the lymph node status and extracapsular lymph node extension (ECE) of the neck for the development of distant metastases in squamous cell carcinoma of the larynx. METHODS: One hundred sixty-five patients treated for laryngeal carcinoma with a neck dissection with histologic evaluation were included. Primary study end point was distant metastasis-free survival. Univariate analysis with the Kaplan-Meier method was used to calculate distant metastasis-free survival and overall survival for the whole group and for groups according to ECE/lymph node status. Patients were classified as 1) no metastatic lymph nodes, 2) metastatic lymph nodes without ECE, or 3) metastatic lymph nodes with ECE. Univariate Cox regression was performed with outcome distant metastasis-free survival. RESULTS: The median overall survival for the whole group was 5.1 years and the 5-year survival rate was 51%. The median distant metastasis-free survival for the whole group could not be calculated and the 5-year metastasis-free survival rate was 78%. The hazard ratio was 3.4 (95% confidence interval [CI] = 1.0-12.1) for patients with positive nodes and without ECE and 10.5 (95% CI = 3.6-30.8) for the patients with metastatic nodes and with ECE compared with the patients without metastatic lymph nodes. CONCLUSION: The presence of ECE in metastatic lymph nodes augments the risk of distant metastasis by nine times in laryngeal carcinoma. Metastatic lymph nodes without ECE show a risk three times greater.     

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。     

Prognostic Value of Histopathologic Parameters and DNA Flow Cytometry in Squamous Cell Carcinoma of the Pyriform Sinus

A retrospective study of a group of 51 patients who underwent surgery for squamous cell carcinoma of the pyriform sinus was performed. Primary tumors and lymph nodes were reviewed histologically. The primary tumors were also examined by flow cytometry for DNA ploidy and cell cycle analysis. Sixteen (33%) of the cases were aneuploid and 64% had a moderate or high S-phase fraction. The overall 3-year survival rate was 49% (25/51). In the univariate analysis, tumor size, lymphatic invasion, inflammatory infiltrate, presence of lymph node metastases, clinical and histologic N status, size and number of lymph nodes involved, and presence of extracapsular extension all correlated with survival. When multivariate analysis was used, the only independent prognostic factors were tumor size, lymphatic invasion, and histologic N status. Ploidy and S-phase fraction did not contribute further prognostic information.