口腔鳞状细胞癌患者颈部淋巴结特征与预后的关系

目的： 探讨口腔鳞状细胞癌（oral squamous cell carcinoma,OSCC）患者颈部阴性淋巴结临床、病理形态特征,并研究其与颈淋巴结转移、复发及总生存期的关系。方法： 回顾分析2017年1月—2021年1月新疆医科大学第一附属医院收治的100例OSCC患者的临床病理资料,研究终点事件为颈淋巴结转移、复发和死亡,采用Kaplan-Meier法绘制生存曲线,Cox生存分析法探讨不同因素与患者预后的关系。采用SPSS 21.0软件包对数据进行统计学分析。结果： 100例患者平均随访时间为30个月,失访10例。90例患者中,出现颈淋巴结转移、复发11例（12.2%）、死亡28例（31.1%）,阴性淋巴结出现窦组织细胞增生（sinus histiocytosis, SH）27例（30%）,3年无颈淋巴结转移复发率为89.4%,3年总生存率为67.3%。90例患者的Cox回归生存分析结果显示,分化程度、N分期、临床分期对总生存期有显著影响（P<0.05）;吸烟、初次颈淋巴结转移（N≠0）、SH、行双侧颈淋巴清扫术对颈淋巴结转移、复发有显著影响（P<0.05）,且吸烟、初次颈淋巴结转移、SH、行双侧颈淋巴清扫术患者的颈淋巴结转移、复发概率较高。结论： SH、初次颈淋巴结转移是导致OSCC患者颈淋巴结转移、复发的独立危险因素,N分期是导致患者死亡的独立危险因素。

Relationship between cervical lymph node characteristics and prognosis in oral squamous cell carcinoma

PURPOSE: To investigate the clinical and pathological features of cervical negative lymph nodes in oral squamous cell carcinoma (OSCC), and to study its relationship with neck recurrence and overall survival in OSCC patients. METHODS: A total of 100 OSCC patients who were treated in the First Affiliated Hospital of Xinjiang Medical University from January 2017 to January 2021 were retrospectively analyzed. The end points of the study were neck recurrence and death.Survival curve was analyzed by Kaplan-Meier and Cox proportional hazards regression analysis was used to investigate the factors of prognosis in OSCC. SPSS 21.0 software package was used for data analysis. RESULTS: The average follow-up time of 100 patients was 30 months, and 10 patients were lost to follow-up. Among the 90 patients,11 cases (12%) had recurrence of cervical lymph node metastasis, 28 cases(31.1%) died, 27 cases (30%) had sinus histiocytosis(SH) in negative lymph nodes, the 3-year recurrence-free rate was 89.4%, and the 3-year overall survival rate was 67.3%. Cox proportional hazards regression analysis of 90 patients showed that degree of tumor differentiation, N stage and clinical stage had significant influence on OS (P<0.05). Smoking, cervical lymph node metastasis in the first operation (N≠0), SH and bilateral neck dissection had significant influence on neck recurrence (P<0.05), and patients who smoked, with cervical lymph node metastasis in the first operation, accompanied by SH and underwent bilateral neck dissection had higher probability of neck recurrence. CONCLUSIONS: SH and primary cervical lymph node metastasis are independent risk factors for the recurrence and metastasis of cervical lymph node in OSCC patients. N stage is survival prognostic factor.