头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。

Occult cervical lymph node metastases from squamous cell carcinomas of the head and neck

Objective To investigate the patterns and characteristics of occult cervical lymph node metastases from the squa-mous cell carcinomas of the head and neck. Methods Clinico-pathological findings from primary tumor and pathologic sections of radical neck dissections were retrospectively studied in 111 patients with head and neck squamous cell carcinomas. Results Occult lymph node metastasis occurred in 26.12% (29/111) of patients in the present serials, with 18.8% (15/80) in oral cavity cancers, 25.00% (1/4) in oropharyngeal cancers, 54.44% (6/11) in hypopharyngeal cancers, and 43.75% in laryngeal cancers. Tumor factors such as T-staging, differentiation and depth of infiltration of the primary cancers were important factors in determining the occult lymph node metastases in the head and neck cancers. Five-year postoperative survival rate was 73.39% (61/82)in patients with negative lymph nodes and 44.82% (13/29) in patients with positive lymph nodes. Conclusion In patients with cN0 neck of some undesirable tumor factors such as late T-staging, poor differentiation and deep tumor infiltration, neck dissections are strongly recommended to treat the occult lymph node metastases in order to improve the outcomes.