舌鳞癌隐匿性颈淋巴结转移与临床病理相关因素的关系

背景与目的:舌鳞癌的某些临床、组织病理学特征与隐匿性颈淋巴结转移密切相关。本研究旨在探讨舌鳞癌隐匿性颈淋巴结转移与原发灶临床和病理的相关性。方法:选择1988～1996年间在我院治疗、有隐匿性颈淋巴结转移的舌鳞癌患者35例;另选择同期无颈淋巴结转移的舌鳞癌患者35例,在显微镜下测量肿瘤浸润深度、评定组织病理学参数。结果:70例cN0舌鳞癌中,大体形态为浸润加溃疡型、浸润型、溃疡型和外生型4组的隐匿性颈淋巴结转移率分别为70.37%、41.67%、40.00%和27.27%;T1、T2和T43组分别为44.00%、43.48%和62.64%;肿瘤浸润深度<4mm、4～7.9mm和≥8mm3组的隐匿性颈淋巴结转移率分别为14.29%、61.54%和88.89%;癌周淋巴细胞反应“+”、“++”和“+++”3组分别为73.68%、58.62%和18.18%;脉管侵犯和无脉管侵犯两组分别为85.71%和46.03%;病理为高、中和低分化3组分别为52.63%、42.31%和66.67%;浸润方式为Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型4组分别为40.9%、50.0%、52.0%和80.0%。单因素分析显示原发肿瘤的大体形态、肿瘤浸润深度、癌周淋巴细胞反应程度和脉管侵犯等参数与舌鳞癌隐匿性颈淋巴结转移的相关性有统计学意义(P<0.05),而T分期、病理分化程度和浸润方式等参数与隐匿性颈淋巴结转移的相关性无统计学意义(P>0.05);Logi

Clinical and pathological related factors of occult cervical lymph node metastasis in squamous cell carcinoma of tongue

BACKGROUND & OBJECTIVE: Some clinical and histopathological features of squamous cell carcinoma of tongue (TSCC) were closely associated with occult cervical lymph node metastasis (OCLNM). This study was designed to investigate the correlation between occult cervical lymph node metastasis in squamous cell carcinoma of tongue and the clinicopathological indexes of primary tumor tissue. METHODS: Thirty-five TSCC patients with OCLNM treated in Cancer Center, Sun Yat-sen University from 1988 to 1996 were enrolled. According to random principle, 35 TSCC patients without OCLNM at the same period were selected. Tumor deepness was measured and pathological parameters were assessed under microscope. RESULTS: The rates of OCLNM in group of infiltrative plus ulcerative type, group of infiltrative type, group of ulcerative type and group of exogenous type were 70.37%, 41.67%, 40.00%, and 27.27%, respectively; the rates of OCLNM in T1, T2, and T4 were 44.00%, 43.48%, and 62.64%, respectively. The rates of OCLNM in groups of tumor deepness < 4 mm, 4-7.9 mm, and > or = 8 mm were 14.29%, 61.54%, and 88.89%, respectively. The rates of OCLNM in groups of response of peritumoral lymphocyte +, ++ and +++ were 73.68%, 58.62%, and 18.18%, respectively. The rates of OCLNM in groups of with vascular invasion and without vascular invasion were 85.71% and 46.03%, respectively. The rates of OCLNM in groups of well, moderate, and poor differentiation were 52.63%, 42.31%, and 66.67%, respectively. The rates of OCLNM in groups of invasive patterns of type I, type II, type III, and type IV were 40.90%, 50.00%, 52.00%, and 80.00%, respectively. Univariate analysis indicated that OCLNM in TSCC was closely associated with gross appearance of primary tumor, tumor deepness, response degree of peritumoral lymphocyte and vascular invasion (P < 0.05), but was not associated with T stage, pathological differentiation, and invasion way (P > 0.05); Logistic multivariate analysis manifested that only tumor deepness and response degree of peritumoral lymphocyte significantly correlated with OCLNM in TSCC. CONCLUSION: There was significant correlation between gross appearance of primary tumor, tumor deepness, response degree of peritumoral lymphocyte and vascular invasion and OCLNM in TSCC. These parameters can be used to predict occult cervical lymph node metastasis in TSCC.