下咽癌颈淋巴结转移的规律及其对预后的影响

  目的  探讨下咽癌颈淋巴结转移的规律、相关因素及其对预后的影响，以指导制定下咽癌的治疗策略。  方法  回顾性分析2000年1月至2016年12月天津医科大学肿瘤医院收治的140例经手术治疗的下咽癌患者临床资料，采用χ2检验行计数资料分析，采用Kaplan-Meier法进行生存分析，采用Cox模型对影响预后的因素进行多因素分析。  结果  140例患者中，颈淋巴结总转移率为68.6%，cN0期患者隐匿性转移率为25.0%，双侧颈淋巴结转移率为25.0%；淋巴结转移最常见区域Ⅱ、Ⅲ、Ⅳ区转移率分别为44.6%、45.2%、18.2%；Ⅰ、Ⅴ、Ⅵ区淋巴结转移率分别为10.7%、10.4%、7.9%。66.7%转移淋巴结伴有结外侵犯。单因素分析显示颈淋巴结转移与肿瘤病理分级关系密切（P=0.012），与性别、年龄、原发病灶部位、肿瘤T分期均无关（均P > 0.05）。本组患者3、5年总生存率分别为61.0%、49.1%。Cox回归分析表明转移淋巴结的直径（P=0.012）、数量（P=0.039）、结外侵犯（P=0.010）与下咽癌患者生存率明显相关。当转移淋巴结直径≥2.8 cm、数量≥2枚、伴有结外侵犯时预后较差。  结论  下咽癌恶性程度高，易发生颈部淋巴结转移，预后较差。颈淋巴结转移是影响患者预后的重要因素，对影响预后的淋巴结因素采取个体化治疗策略是提高下咽癌治疗效果的关键。 

Cervical lymph node metastasis regularity of hypopharyngeal carcinoma and its influence on prognosis

  Objective  To investigate the regularity of cervical lymph node metastasis of hypopharyngeal carcinoma and its influence on patient prognosis, to guide the therapeutic strategies for hypopharyngeal carcinoma.  Methods  A total of 140 hypopharyngeal squmous cell carcinoma patients who received surgery in Tianjin Medical University Cancer Institute and Hospital from January 2000 to December 2016 were analyzed retrospectively. χ2 test was adopted for the analysis of the counting data, and Kaplan-Meier method was used for survival analysis, and the Cox regression model was used to analyze the factors affecting the prognosis.  Results  The total rate of lymph node metastasis was 68.6% of the total 140 patients. The rate of occult lymph node metastasis in cN0 patients was 25.0%. The rate of bilateral lymph node metastases was 25%. The most common areas of lymph node metastasis are region Ⅱ, Ⅲ, and Ⅳ. The rates of lymph node metastasis were 10.7%, 10.4%, 7.9% in region Ⅰ, Ⅴ and Ⅵ, respectively. The total rate of extranodal extension were 66.7%. Univariate analysis showed that cervical lymph node metastasis was closely related to tumor pathological grade (P=0.012), and was not related to gender, age, primary tumor site, tumor T stage (P < 0.05). The 3-year and 5-year overall survival rates of patients were 61.0% and 49.1%, respectively. Cox regression analysis showed that the diameter of metastatic lymph nodes (P=0.012), number (P=0.039), and extranodal extension (P=0.010) were significantly related to the survival of patients with hypopharyngeal carcinoma. When the diameter of metastatic lymph nodes ≥2.8 cm, number≥2, with extranodal extension, the prognosis is poor.  Conclusions  Hypopharyngeal carcinoma has a dismal prognosis, with high rate of lymph node metastasis. Cervical lymph node metastasis is an important factor of the prognosis. The active treatment strategy for the lymph nodes is the key to improve the therapeutic effect of hypopharyngeal carcinoma.