186例下咽癌颈淋巴结转移规律影像学分析

本研究拟通过计算机体层摄影（CT）/磁共振成像（MRI）分析下咽癌颈部淋巴结转移特点及规律，探讨Ⅵ区淋巴结转移发生的相关影响因素，为临床治疗提供参考。方法:收集2000年8月至2010年12月期间中山大学肿瘤防治中心的下咽癌病例186例，均经病理证实，行治疗前CT/MR检查。统计学方法采用χ2检验和Logistic多因素分析。结果:下咽癌淋巴结转移率为79%，Ⅱ、Ⅲ区转移最常见，转移率分别为72.0%、54.8%。在有淋巴结转移患者中，咽后壁癌和环后区癌双侧淋巴结转移率分别为53.3%和50.0%，梨状窝癌原发灶侵犯过中线后对侧淋巴结转移率（40.0%）较未过中线者（11.1%）明显增高（P<0.001）。单因素和多因素分析显示Ⅳ区转移、咽后淋巴结转移和食管受侵与Ⅵ淋巴结转移关系密切。结论:下咽癌淋巴结转移率高，转移遵循一定的规律，跳跃性转移少见。咽后壁癌和环后区癌及梨状窝癌侵犯过中线后易发生双侧淋巴结转移。Ⅳ区转移、食管受侵和咽后淋巴结转移可能是Ⅵ区淋巴结转移的独立影响因素。 

Imaging-based Analysis of Metastatic Cervical Lymph Nodes in 186 Hypopharyngeal Carcinoma Cases

To explore the characteristics and regulation of cervical lymph node metastases in hypopharyngeal carcinoma through computed tomography ( CT ) and magnetic resonance imaging (MRI), and to discuss the related factors to provide reference for clinical treatment. Methods: A retrospective analysis of patients treated at the Cancer Center of Sun Yat-sen University between August 2000 and December 2010; all 186 cases of hypopharyngeal carcinoma were pathologically confirmed and received pretreatment CT/MR examination. Univariate χ2 and multivariate logistic tests were used for statistical analysis. Results: The rate of regional lymph node metastasis for hypopharyngeal carcinoma was 79%; level II and III were the most common places of metastasis, with lymph node metastasis rates of 72.0% and 54.8%, respectively. The bilateral metastasis rates for pharyngeal wall and post-cricoid carcinoma were 53.3% and 50.0% among patients with lymph nodes metastasis. The contralateral lymph node metastasis rate for pyriform sinus carcinoma that invaded across the midline ( 40.0% ) was significantly higher than those that did not ( 11.1% ) ( P < 0.001 ). Both univariate and multivariate analysis revealed that a metastatic level of IV, metastasis to retropharyngeal lymph nodes, and esophageal invasion were significantly correlated with level VI lymph node metastasis. Conclusion: The incidence of lymph node metastasis in hypopharyngeal carcinoma is high, and follows specific patterns. The skip metastasis is rare. Midline tumors such as pharyngeal wall and post-cricoid carcinomas, as well as pyriform sinus carcinomas that invade across the midline are much more prone to have bilateral lymph node metastasis. Level IV metastasis, esophageal invasion, and retropharyngeal lymph node metastasis are likely independent factors for level VI metastasis.