Ozdek A, Sarac S, Akyol M U, Unal O F, Sungur A
Department of Otolaryngology, Hacettepe University School of Medicine Ankara, Turkey.
Eur Arch Otorhinolaryngol. 2000;257(7):389-92. doi: 10.1007/s004050000231.
Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease.
淋巴结转移似乎是决定喉鳞状细胞癌患者生存率的最重要因素。由于声门上喉癌存在广泛的淋巴管网，因此已知其有转移至颈部淋巴结的倾向。本项回顾性队列研究旨在确定可能影响颈部淋巴结转移的组织病理学参数，然后利用这些参数创建一个量表，以预测声门上鳞状细胞癌的隐匿性淋巴结转移。对61例手术患者的病理切片重新评估肿瘤分级、淋巴管血管浸润、肿瘤边缘浸润模式、神经周围浸润和淋巴细胞浸润情况。结果发现，分级（P < 0.001）、淋巴管血管浸润（P < 0.001）和肿瘤边缘（P = 0.007）与颈部转移密切相关。为了确定隐匿性转移的危险因素，利用患者的分级（G）、淋巴管血管浸润（L）和肿瘤边缘（M）结果创建了一个分级量表。GLM值为零的患者均未发生隐匿性转移。另一方面，GLM值大于零的N0患者中，58.8%发生了隐匿性转移。这些发现表明，具有浸润性边界和淋巴管血管浸润的高级别肿瘤患者发生隐匿性转移的风险较高，因此应在治疗中增加对颈部进行选择性颈清扫或放疗。需要对标本进行连续切片，以避免遗漏疾病的转移位点。
