喉癌临床N0患者颈淋巴结转移的病理研究

目的探讨喉癌临床Ｎ０患者颈淋巴结转移特点,为颈淋巴结处理方式选择提供根据。方法４０例临床Ｎ０喉癌患者被随机分为选择性根治性颈廓清术（ｒａｄｉｃａｌｎｅｃｋｄｉｓｅｃｔｉｏｎ,ＲＮＤ）及功能性颈廓清术（ｆｕｎｃｔｉｏｎａｌｎｅｃｋｄｉｓｅｃｔｉｏｎ,ＦＮＤ）两组,分别完成１３及２７例。将获得淋巴结逐一行病理检查,以确定转移情况。结果ＲＮＤ组平均每侧获淋巴结３４．２枚,ＦＮＤ组为２７．４枚,差异无显著性（ｔ＝０．８６,Ｐ＞０．０５）。两组颈淋巴结转移率分别为３０．８％（４／１３）及３３．３％（９／２７）,总转移率为３２．５％（１３／４０）。１３例颈淋巴结转移阳性病例中１２例（９２．３％）转移淋巴结位于Ⅱ,Ⅲ区。３３枚转移阳性淋巴结中３２枚（９６．９％）位于第Ⅱ和Ⅲ区。两组３年生存率分别为６９．２％（９／１３）及７７．８％（２１／２７）,统计学差异无显著性（χ２＝０．３４１８,Ｐ＞０．５）,总的３年生存率为７５％（３０／４０）。结论对临床Ｎ０喉癌患者行肩胛舌骨肌上或侧颈廓清术较为适宜。     

声门上型喉癌临床N_0病理转移的观察

目的：为探讨喉癌颈淋巴结转移的规律，选择手术方法。方法：采用１１０例临床Ｎ０声门上型喉癌的１６４侧颈廓清术标本淋巴结连续切片方法观察。结果：发现颈淋巴结转移率为３５．５％（３９／１００）。提出临床Ｎ０病理转移的特点：１）转移淋巴结大小大多数介于０．５～１．５之间占８４．２％。２）转移淋巴结大多数为早期侵入期和生长发展期占８６．０％。３）转移淋巴结绝大多数为单发型占７４．４％。４）各个Ｔ分期均有转移淋巴结。结论：在颈淋巴结处理上，我们支持尽可能同期行选择性颈廓清术的观点     

喉癌颈部淋巴结转移的MRI诊断

目的：探讨ＭＲＩ在喉癌颈部淋巴结转移术前诊断中的作用。方法：对１９例（２４侧）喉癌患者的颈部术前触诊、ＭＲＩ扫描及颈清扫标本病理检查结果进行了对比研究。结果：喉癌颈辨别志移淋巴结在ＭＲＩ影像上基本呈圆形或类圆型,个别可表现为数个淋巴结的融合;ＭＲＩ和临床触诊诊断颈部淋巴结转移的敏感率、特异率和准确率分别为８５．７％、９０．０％、８７．５％和６４．３％、７０．０％、６６．７％,ＭＲＩ诊断的准确率明显     

头颈部鳞状上皮细胞癌部N0的处理——声门上型喉癌

对声门上型喉癌颈部无肿大转移淋巴结患者，进行回顾性分析，探讨适宜的处理方案。我院自１９７６年至１９９０年共外科治疗１６２例Ｔ１￣４Ｎ０患者。原发处进行各类学术治疗，颈部做上颈淋巴结切除术。有１３例冰冻病理检查阳性，即做颈清扫术。１４９例病理阴性者观察随诊５年。颈部复发或转移者１５例，颈部失败率为１０．１％。全组５年生存率：Ｔ１Ｎ０为９２．８％，Ｔ２Ｎ０为８６．５％，Ｔ３Ｎ０为６９．７％，Ｔ４Ｎ０为     

声门上型喉癌cN0患者颈淋巴结转移的临床病理研究

为探讨声门上型临床颈淋巴结一喉癌病人颈淋巴结转移规律并为外科治疗的选择提供理论根据，对３５例ＣＮ０声门上型喉癌被随机分为选择性根治性颈廓清（ＥＲＮＤ）及选择性功能性颈廓清（ＥＦＮＤ）两组，分别完成１２及２３例。ＥＲＮＤ组平均每颈获取淋巴结３２．５枚，ＥＦＮＤ组２９．８枚，差异不显著。两组颈淋巴结转移率分别为３３．３％及３０．４％，总转移率为３１．４％，１１例颈淋巴结ＰＮ病例中有１０例（９０．９％）     

P^16抑癌基因与喉癌颈淋巴结转移和恶性度关系的探讨

目的：为了探讨Ｐ＾１６蛋白表达与喉癌颈淋巴结转移及瑟癌组织恶性度的关系。方法：用免疫组化ＳＰ法对８２例声门上型喉癌的原发灶、癌旁组织及颈淋巴进行了Ｐ＾１６蛋白表达的检测。结果：喉癌原发灶中Ｐ＾１６蛋白表达阳性率５４．９％；其中无颈淋巴结转移组阳性率为６８．３％；有颈淋巴结转移组的阳性率４１．５％，差异有显著性意义（Ｐ〈０．０５）。低度恶性组原发灶中Ｐ＾１６蛋白表达阳性率６２．２％；高度恶性组原发灶     

声门上癌术后颈淋巴结的转移与再发

目的探讨选择性颈廓清术在声门上癌手术治疗中的作用。方法总结１９８１～１９９３年治疗的５８２例声门上癌术后颈淋巴结转移及廓清侧转移淋巴结再发情况。结果Ｔ３、Ｔ４病例３９２例（６７．４％），而Ｔ３Ｎ＋、Ｔ４Ｎ＋１４７例（３７．５％）。Ｔ３、Ｔ４占全组Ｎ＋的８６．５％（１４７／１７０）。Ｎ０未行颈廓清术１２６例，术后发生同侧及双侧颈淋巴结转移３３例，其９０．９％在Ｔ３、Ｔ４组（３０／３３）。Ｎ０行选择性颈廓清术２８６例，术后发生对侧转移４０例，其７５％也在Ｔ３、Ｔ４组（３０／４０）。对二次住院治疗的１６３例进行了随访。二期选择性颈廓清组３、５年生存率为８６．７％及７７．８％，术后转移组及术后再发组分别为６４．８％、３２．５％及３３．３％、３０．８％。组间有明显差异。结论对声门上癌Ｔ３、Ｔ４的Ｎ０病例应行选择性颈廓清术。出现转移后再行颈廓清术者疗效明显下降。声门上癌部分Ｔ２Ｎ０病例（如杓会厌皱襞癌、杓区癌或杓区受累、肿瘤＞２．０ｃｍ、溃疡型、周边呈浸润生长等）也不属早期病例，应行选择性颈廓清术     

喉部分切除术的临床评价

对资料完整的１３５例喉部分切除术的喉癌患者进行了疗效分析，３、５年生存率分别为８６．７％和８３．８％。Ⅰ和Ⅱ期的３、５年生存率为９３．８％和９０．６％，高于Ⅲ和Ⅳ期（７６．４％，７０．４％）；声门区癌３、５年生存率（９０．５％，８７．７％）高于声门上区（７３．３％，６６．７％）。局部复发１４例，颈部转移１１例，远处转移２例，１４例行再次手术治疗，术后２年生存率为６４．３％。所有患者的发音功能均可保留，但受到不同程度的损害；６２．９％的患者术后有不同程度的误吸，经训练后大多可正常进食，只有１例需二次手术关闭喉口。７６．３％的患者可拔管，在已拔管的患者中有２１．４％诉有轻度呼吸不畅，但不影响日常工作。提出喉癌患者行喉部分切除术后的疗效评价应包括两个方面：肿瘤切除的彻底性（生存率）和喉功能恢复的程度。     

声门上型喉癌颈淋巴结隐匿性转移

目的探讨声门上型喉癌隐匿性颈淋巴结转移的特点和规律。方法对１００例声门上型喉癌临床Ｎ０患者和颈廓清标本（１５３侧）进行连续切片,光镜观察。结果隐匿性转移率为３８％,发现转移淋巴结５１个,Ⅰ区１个（２％）,Ⅱ区３７个（７３％）,Ⅲ区１２个（２３％）,Ⅳ区１个（２％）,转移淋巴结的长径０．５～２．６ｃｍ,平均为１．１ｃｍ。５１个淋巴结中癌早期２１个（４１％）,癌长期１８个（３５％）,癌满期７个（１４％）,破膜期５个（１０％）。结论声门上型喉癌颈淋巴结的隐匿性转移率高,早期不易诊断,应积极行选择性颈廓清术。     

头颈鳞癌颈部N_0的局限性颈清扫术

目的：头颈部肿瘤颈部Ｎ０的处理有不同意见。本文提供两组病例：一组为１４９例喉癌声门上型;一组为２１９例舌活动部癌。试图从这两组患者治疗结果讨论Ｎ０适宜治疗。方法：我科于１９７６～１９９０年外科或综合治疗声门上型喉癌１４９例;１９６０～１９９３年外科或放射治疗舌活动部鳞癌２１９例。这两类病种均易有颈淋巴结转移,均为Ｔ１～４Ｎ０病例。声门上癌颈部做上颈清扫术;舌癌大部做全颈清扫术。两组原发灶以手术或放射治疗。利用手术标本病理检查及随诊资料进行分析讨论。结果：声门上型喉癌Ｎ０上颈清扫术后,病理无淋巴结转移者１４９例（病理有转移者立即做全颈清扫,不包括在这一组内）,５年观察后有１５例（１０．１％）出现颈转移。和文献报告全颈清扫后复发率可以相比。２１９例舌癌患者１１６例做全颈清扫,病理阳性率为１９．８％（２３／１１６）。３年观察后颈部复发的病例如下：原发与颈部放疗者１７．２％（１０／５８）;颈部无治疗者１６．１％（５／３１）;颈清扫病理阴性者１２．０％（１０／８３）。统计学上无差别。结论：对Ｎ０患者,无需做经典性全颈清扫术。对声门上型患者,上颈清扫（Ⅱ组淋巴结）做为诊断措施可以解决问题,进一步可以考虑肩胛舌骨肌上清扫     

Determination of lymph node micrometastases in patients with supraglottic carcinoma

CONCLUSIONS: The frequency of loss of heterozygosity (LOH) at D9S 171 microsatellite locus on 9p21 may serve as an available method to evaluate occult micrometastases in laryngeal squamous cell carcinoma. High frequency of LOH was associated with a decreased probability of survival time. OBJECTIVE: To explore an available and sensitive method to detect cervical lymph node micrometastases in patients with laryngeal squamous cell carcinoma, the frequency of LOH at D9S171 microsatellite locus on 9p21 was studied. PATIENTS AND METHODS: Twenty samples from supraglottic cancer and 182 lymph nodes from neck dissections were examined by LOH comparing immunohistochemical (IHC) staining using cytokeratin 19 (CK19), and hematoxylin and eosin (H&E) staining. The frequency of lymph node metastasis and the clinical relevance were analysed. RESULTS: The frequency of LOH was 37.4% of lymph nodes and all of the primary tumors. Occult micrometastases were present in 9 of 20 cases; 23.6% of lymph nodes were positive for CK19 by IHC; 16.5% of lymph nodes were positive by H&E. There was a highly significant difference among the three methods. The highest rate of positive lymph nodes was at level II of the neck. There was a highly significant difference between overall survival time and lymph node metastasis with LOH and CK19 analysis.     

Prognostic importance of lymphatic reaction pattern in laryngeal carcinoma.

PURPOSE: Cervical lymph node status is a widely accepted important prognostic parameter in laryngeal carcinoma. PATIENTS AND METHODS: In this study, we retrospectively reviewed neck specimens of 46 laryngeal carcinoma patients operated in our clinic. Presence of neck metastasis and pattern of reactivity in nonmetastatic nodes was correlated with recurrence and survival during a follow-up period of at least 2 years. RESULTS: Fourteen of the patients had at least one metastatic node and survival was 64%; 32 of the patients had reactional nodes only and the survival was 81%. Pattern of lymph node reactivity was evaluated as stimulated in type I (lymphocyte predominance) and type II (germinal center predominance); as unstimulated in type III (histiocytosis and/or normal) and type IV (lymphocyte depletion). Thirty two neck [-] patients had reactional nodes--16 of them were classified as stimulated and 16 of them as unstimulated; the 2-year survivals were 94% and 68%, respectively. In the 14 patients with cervical metastasis (classified according to nonmetastatic reactional nodes) 9 were stimulated and 5 were unstimulated with 2-year survivals of 100% and 0%, respectively. CONCLUSION: Stimulated lymphatic pattern reflects a better prognosis, especially in N+ neck laryngeal cancer patients.     

声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择

目的　探讨声门上型喉癌临床诊断N0 (clinicalN0 ,cN0 )患者颈淋巴结转移的特点 ,选择合理的清扫区域。方法　 5 7例声门上型喉癌患者行喉切除术的同时行改良性颈清扫术 ,将颈清扫的淋巴结标本分区域逐一行病理学检查 ,确定转移区域或复发的区域。结果　 5 7例 (6 3侧 )颈清扫标本共获淋巴结 1877枚 ,平均每侧获 2 9 8枚 ,有转移的 4 3枚 ,其中 4 1枚位于Ⅱ、Ⅲ区 ,占 95 4 % (41/ 4 3)。15例 (17侧 )患者有淋巴结转移 ,转移率为 2 6 3% (15 / 5 7)。其中 14例位于Ⅱ、Ⅲ区 ,占转移例数的93 3% (14 / 15 )。颈部复发 3例 ,复发率为 5 3% (3/ 5 7) ,复发部位分别位于Ⅱ、Ⅲ、Ⅳ区。 5年生存率为 80 7% (46 / 5 7)。结论　对声门上型喉癌cN0重点行Ⅱ和Ⅲ区颈淋巴结清扫术 ,Ⅲ区受累时应包括Ⅳ区 ,Ⅰ、Ⅴ区在无明显转移证据时可避免行颈清扫术     

声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择

目的 探讨声门上型喉癌临床诊断NO(clinical NO,cNO）患者颈淋巴结转移的特点，选择合理的清扫区域。方法 5例声门上型喉癌患者行喉切除术的同时行改良性颈清扫术，将颈清扫的淋巴结标本分区域逐一行病理学检查，确定转移区域或复发的区域。结果 57例（63侧）颈清扫标本共获淋巴结1877枚，平均每侧获29．8枚，有转移的43枚，其中41枚位于Ⅱ、Ⅲ区，占转移例数的95．4％（41／43）。15例（17侧）患者有淋巴结转移，转移率为26．3％（15／57）。其中14例位于Ⅱ、Ⅲ区，占转移例数的93．3％（14／15）。颈部复发3例，复发率为5．3％（3／57），复发部位分别为Ⅱ、Ⅲ、Ⅳ区。5年生存率为80．7％（46／57）。结论 对声门上型喉癌cNO重点行Ⅲ和Ⅲ区颈淋巴结清扫术，Ⅲ区受累时应包括Ⅳ区，Ⅰ、Ⅴ区在无明显转移证据时可避免行颈清扫术。     

保留喉功能喉咽癌的手术切除与修复

目的 评价喉咽癌保留喉功能手术临床治疗效果和影响预后因素.方法 回顾性分析1974年9月至2003年7月收治的45例喉咽癌保留喉功能手术临床治疗效果.其中梨状窝癌23例,环后癌13例,喉咽后壁癌9例.术前放疗2例,放疗量40～50 Gy;术后放疗32例,放疗剂量60～70 Gy.分析影响患者生存率的危险因素.结果 45例保留喉功能术后发音清晰者88.9%,发音轻度含混者占11.1%;23例拔除气管套管,拔管率51.1%,全部能进普食.出现术后并发症19例(42.2%);术后颈部淋巴结转移20例,占44.4%.Kaplan-Meier法统计全组患者5年生存率为53.3%.T1+T2组和T3+T4组患者术后5年生存率分别为66.7%和43.3%;cN0和cN1、cN2组生存率分别为65.2%和46.7%、28.6%;病理分化程度高、中和低组生存率分别为62.3%、42.1%和30.8%.单因素分析生存率与术前有无颈淋巴转移及病理分化程度有关(x2值为5.297和11.556,P值为0.021和0.003).Cox回归多因素分析显示,术前有无颈淋巴转移和病理分化程度是影响预后的独立危险因素(x2值为4.365和4.600,P值为0.041和0.032,OR值1.151和0.610).结论 喉咽癌保留喉功能手术为T1、T2患者的最佳术式,部分T3、T4晚期喉咽癌也可以采用保留喉功能手术.正确选择颈清扫的方法,有助于提高喉咽癌保留喉功能手术的生存率.     

Management of contralateral N0 neck in pyriform sinus carcinoma

OBJECTIVE: The hypopharynx has a rich lymphatic network that places patients with tumors of the hypopharynx at high risk for early dissemination of the disease into the cervical lymphatics. Therefore, ipsilateral elective neck dissection of clinically N0 neck in lateralized lesions of hypopharyngeal squamous cell carcinomas (SCCs) is widely accepted as a standard treatment. However, the management of the contralateral N0 neck is still controversial. The aim of this study was to evaluate the incidence and predictive factors of contralateral occult lymph node metastasis in pyriform sinus SCC. MATERIALS AND METHODS: We performed a retrospective analysis of 43 patients with N0 to 3 pyriform sinus SCC with contralateral clinically node-negative necks who had also received contralateral elective neck dissections from 1994 to 2003. Surgical treatment was followed by postoperative radiotherapy in 41 patients. The follow-up period ranged from 4 to 135 months (mean, 40 months). The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS: Contralateral occult lymph node metastases occurred in 16% (seven of 43) of the subjects. Twenty-six percent of the 27 subjects with clinically node-positive ipsilateral neck developed contralateral occult lymph node metastases, whereas 0% of the 16 subjects with N0 ipsilateral necks (P=.035) developed the disease. Moreover, in cases with primary site extension across the midline, the rate of contralateral occult neck metastasis was significantly higher (P=.010). However, there were no statistically significant differences in age, sex, early versus advanced T stage, number of ipsilateral positive nodes, lymph nodes with extracapsular spread, primary subsite of medial versus lateral pyriform sinus, pyriform sinus apex involvement, and growth type. Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5-year disease-specific survival rate, 66% vs. 33%, P<.05). CONCLUSION: The patients with pyriform sinus SCC with clinically ipsilateral N+ neck and/or extension across the midline are at greater risk for contralateral occult neck metastases. Furthermore, patients who present with a contralateral metastatic neck have a worse prognosis than those staged as N0. Therefore, we advocate bilateral neck treatment in patients with pyriform sinus SCC with clinically ipsilateral node metastases and/or extension across the midline.     

不同声门型喉癌喉前淋巴结转移研究

目的　探讨不同声门型喉癌喉前淋巴结转移规律,为喉癌规范手术提供依据。方法　92例声门型喉癌在行不同手术时,皆常规行喉前淋巴结清扫并送检。比较喉前淋巴结阴性组及阳性组在肿瘤分期、病理分型、术后颈部淋巴结复发和局部复发、生存时间之间的差异。结果　92例喉前淋巴结阳性者5例,阳性率5.4%（5/92）,晚期喉癌（III期、IV期）较早期（I期、II期）喉前淋巴结更容易发生转移,差异有统计学意义。喉前淋巴结转移与病理分型差异无统计学意义;喉前淋巴结转移阳性组术后发生颈部淋巴结转移较阴性组高,差异有统计学意义;喉前淋巴结转移阳性组术后局部复发较阴性组高,差异有统计学意义。喉前淋巴结阴性组较阳性组生存时间长,差异有统计学意义。结论 前淋巴结在晚期声门型喉癌中发生转移率较高,手术时应常规清扫;喉前淋巴结一旦转移,其颈部和局部复发几率增加,预后较差,提示进一步的后续规范治疗的重要性。     

Management of contralateral N0 neck in tonsillar squamous cell carcinoma

OBJECTIVES: It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory during initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. MATERIALS AND METHODS: A retrospective analysis of 43 N0-3 tonsillar cancer patients with contralateral clinically negative necks from 1992 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS: Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral N0 necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, P = < .05). CONCLUSION: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contralateral metastatic neck have a worse prognosis than those who are staged as N0. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.     

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。     

Therapeutic outcomes of laryngeal cancer at Kyoto University Hospital for 10 years

CONCLUSION: It is important to prevent regional lymph node recurrence and distant metastasis to achieve better survival of laryngeal cancer. OBJECTIVE: Therapeutic outcomes of 130 cases with laryngeal cancer treated at Kyoto University Hospital between 1995 and 2004 were reviewed. PATIENTS AND METHODS: In all, 121 males and 9 females were involved. Their ages ranged from 40 years to 92 years (average 66 years). All tumors were squamous cell carcinoma - arising at the glottis in 111 cases, the supraglottis in 18, and the subglottis in 1 case. Most glottic cancers (77.5%) were classified as stage I or II, while most supraglottic cancers (77.8%) were at stage III or IV. Stage I/II cancers were basically treated by conventional radiotherapy (60-66 Gy) and twice-daily hyperfractionated radiotherapy (70-74 Gy), respectively, attempting to preserve the larynx. Total laryngectomy with neck dissection was performed in the treatment of stage III/IV cases. RESULTS: Five-year disease-specific survival rates were 100%, 96%, 100%, and 68% for stage I, II, III, and IV, respectively. Five-year laryngeal preservation rates were 98%, 100%, 86%, 0%, and 0% for T1a, T1b, T2, T3, and T4 of glottic cancer, respectively. Local recurrence occurred in five cases of stage I/II glottic cancer, which was successfully salvaged. Regional lymph node recurrence occurred in five cases including four patients with glottic cancer and one with supraglottic cancer. Two of them died of disease despite undergoing salvage therapy. Distant metastasis occurred in the lung in four cases including one glottic and three supraglottic cancer patients after initial treatment.