舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响

背景与目的:舌鳞癌隐匿性颈淋巴结转移有一定的规律性,且影响预后。本研究的目的是分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响,为选择性肩胛舌骨肌上颈清扫提供临床依据。方法:收集1990～1996年间在我院住院行手术治疗的164例舌鳞癌患者的资料,分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响。结果:164例舌鳞癌隐匿性颈淋巴结转移率为25.71%,最常见的转移部位是同侧的Ⅱ区,其次分别为同侧的Ⅰ和Ⅲ区,82.98%隐匿性转移的颈淋巴结位于以上3个区域,大多数隐匿性转移的颈淋巴结在首次手术治疗后2年内(33/36)被发现。经统计学分析,显性颈淋巴结转移和隐匿性颈淋巴结转移与无转移组之间患者的预后有显著性差异(log-rank,P<0.01),而显性转移组与隐匿性转移组患者的预后之间无显著性差异(log-rank,P>0.05)。结论:同侧的Ⅰ～Ⅲ区是舌鳞癌隐匿性颈淋巴结转移的常见区域,对较易发生隐匿性颈淋巴结转移的cN0舌鳞癌患者可行选择性肩胛舌骨肌上颈清扫术。隐匿性颈淋巴结转移影响cN0舌鳞癌患者的预后。

Characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on prognosis

BACKGROUND & OBJECTIVE: Occult cervical lymph node metastasis in squamous cell carcinoma of tongue has regularity and influence on the prognosis of patients. This study was designed to investigate the characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis to provide clinical bases for elective supraomohyoid neck dissection. METHODS: The data of 164 patients with squamous cell carcinoma of tongue who were treated in cancer center, Sun Yat-sen University, from 1990 to 1996 were reviewed. The characteristics of occult cervical lymph node metastasis in squamous cell carcinoma of tongue and their influence on the prognosis were analyzed. RESULTS: The rate of occult cervical lymph node metastasis of squamous cell carcinoma of tongue was 25.71%. The most common site of occult cervical lymph node metastasis was ipsilateral level II, and followed by ipsilateral level I and III. 82.98% of the lymph nodes of occult metastasis occurred in the above three levels. Most cervical lymph nodes of occult metastasis were found within two years after the first operation (33/36). There was significant difference of the prognosis between the group of dominant or occult cervical lymph node metastasis and the group of without cervical lymph node metastasis in squamous cell carcinoma of tongue (log-rank,P< 0.01); whereas there was no significant difference of the prognosis between the group of dominant cervical lymph node metastasis and the group of occult cervical lymph node metastasis according to log-rank test (P >0.05). CONCLUSION: The ipsilateral level I to level III were the common regions where occult cervical lymph node metastasis occurred. The authors suggest that elective supraomohyoid neck dissection may be applied to clinically negative neck of the patients with squamous cell carcinoma of tongue who were prone to metastasize latently. Occult cervical lymph node metastasis influences the prognosis of patients with squamous cell carcinoma of tongue significantly.