Remmert S, Rottmann M, Reichenbach M, Sommer K, Friedrich H J
Laryngorhinootologie. 2001 Jan;80(1):27-35. doi: 10.1055/s-2001-11027.
One of the most important criteria of malignancy of head and neck cancer are the cervical lymph metastases. Being significant for the therapeutical plan is how tumor depending parameters like T-stage, degree of differentiation and tumor localisation will influence the N-stage and therefore the extension of neck dissection.
To evaluate the pattern of formations of metastases and the success of therapy a retrospective study was performed on 405 patients with carcinoma of the oral cavity (n = 47), the oropharynx (n = 117), the hypopharynx (n = 47) and the larynx (n = 193).
By the time of surgery carcinoma of the hypopharynx were most frequently accompanied by cervical metastases (80%), followed by carcinoma of the oropharynx (70%), the oral cavity (52%) and the larynx (26%). Occurrence and extension of regional lymph node metastases correlated well with T-stages and degree of differentiation. After surgical therapy locoregional recurrence could be observed in 5.2% of the patients. Five-year-survival rate was reduced to 50% on patients with positive lymph nodes. The different tumour sites showed preferred patterns of metastatic spread, without complete avoidance of certain levels.
For the decision on indication and extent of neck dissection the preoperative diagnostic (ultrasound, CT-scan, MRI), localisation of tumour, T-stage, degree of differentiation and the knowledge of typical metastatic spread must be considered.
头颈部癌恶性程度的最重要标准之一是颈部淋巴结转移。对于治疗方案至关重要的是，肿瘤相关参数如T分期、分化程度和肿瘤定位将如何影响N分期，进而影响颈部清扫的范围。
为评估转移灶的形成模式和治疗效果，对405例口腔癌（n = 47）、口咽癌（n = 117）、下咽癌（n = 47）和喉癌（n = 193）患者进行了回顾性研究。
手术时，下咽癌最常伴有颈部转移（80%），其次是口咽癌（70%）、口腔癌（52%）和喉癌（26%）。区域淋巴结转移的发生和范围与T分期和分化程度密切相关。手术治疗后，5.2%的患者出现局部区域复发。淋巴结阳性患者的5年生存率降至50%。不同肿瘤部位显示出转移扩散的偏好模式，但并未完全避开某些区域。
对于颈部清扫的适应证和范围的决策，必须考虑术前诊断（超声、CT扫描、MRI）、肿瘤定位、T分期、分化程度以及典型转移扩散的知识。
