T3-T4期声门型喉癌颈淋巴结转移情况及其与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率低,有关报道不多,本研究旨在探讨T3-T4期声门型喉癌颈淋巴结转移的相关因素及其对预后的影响。方法:回顾性分析我院1992～2000年收治T3-T4期声门型喉癌83例的临床资料,对颈淋巴结转移率、转移淋巴结的分布、影响cN0颈部复发的因素(颈部预防性放疗、病理分级及T分期)、淋巴结转移与预后的关系。结果:T3-T4期声门型喉癌,总的颈淋巴结转移率为20.5%,cN0颈部复发率为14.3%。绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,仅1例位于对侧Ⅱ区。cN0者中,颈部预防性放疗与颈部观察在颈部复发率上无差异(P=0.772);病理分级影响cN0颈部复发率(P=0.028);不同T分期颈部复发率无差异(P=0.217)。cN 患者预后明显差于cN0患者(P<0.001);cN0颈部复发不影响预后(P=0.460)。对T3-T4期声门型喉癌cN 患者采用治疗性颈清扫;对cN0患者颈部可密切观察,待出现淋巴结复发再积极治疗。结论:T3-T4期声门型喉癌主要转移至同侧Ⅱ、Ⅲ、Ⅳ区;病理组织分化级别越差,cN0颈部复发的风险越大;cN0颈部复发与预后无关;对cN0患者颈部可进行密切观察;对出现淋巴结复发者应积极治疗。

Correlation of cervical lymphatic metastasis to prognosis of T3-T4 glottic cancer

BACKGROUND & OBJECTIVE: The cervical lymphatic metastasis rate of glottic cancer is low, and has seldom been reported. This study was to explore the factors related to cervical lymphatic metastasis of T3-T4 glottic cancer, and analyze its correlation to prognosis. METHODS: Clinical data of 83 patients with T3-T4 glottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 2000, were reviewed retrospectively. The lymphatic metastasis rate, distribution of metastatic lymph nodes, influence factors of neck recurrence of cN0 glottic cancer, and correlation of cervical lymphatic metastasis to prognosis of T3-T4 glottic cancer were analyzed. RESULTS: Overall lymphatic metastasis rate was 20.5%. The neck recurrence rate of cN0 patients was 14.3%. Most metastatic lymph nodes located at the ipsilateral levels II, III, and IV, while only 1 located at the contralateral level II. For cN0 patients, there was no difference in the neck recurrence rate between observation group and prophylactic cervical radiation group (P=0.772). Histopathologic differentiation affected the neck recurrence of cN0 patients (P=0.028); while T stage did not relate to the neck recurrence (P=0.217). The prognosis of cN+ patients was poorer than that of cN0 patients (P<0.001). The neck recurrence of CN0 patients did not affect the prognosis (P=0.460). CONCLUSION: Most metastatic lymph nodes of T3-T4 glottic cancer locate at the ipsilateral levels II, III, and IV. Poor differentiation is significantly correlated to high risk of neck recurrence among cN0 patients. However, the recurrence does not affect the prognosis. Close observation should be done to the cervix of cN0 patients; while neck dissection should be done to cN+ patients.