Stennert Eberhard, Kisner Dilek, Jungehuelsing Markus, Guntinas-Lichius Orlando, Schröder Ursula, Eckel Hans Edmund, Klussmann Jens Peter
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany.
Arch Otolaryngol Head Neck Surg. 2003 Jul;129(7):720-3. doi: 10.1001/archotol.129.7.720.
To analyze the incidence and risk factors for clinically apparent and occult lymph node metastases in patients with major salivary gland cancers.
Cohort of patients with a median follow-up of 46 months (range, 1-174 months).
University-based referral center.
A total of 160 consecutive patients with complete clinical and pathologic data.
Neck dissection was performed in all cases. Patients were treated with surgery alone (55%); surgery and radiation therapy (43%); or a combination of surgery, radiation, and chemotherapy (2%).
Incidence of apparent and occult lymph node metastases. Univariate and multivariate analyses were used to evaluate the significance of clinical and pathologic data.
Histologically confirmed positive neck was found in 53% of all cases. Histologic diagnosis was significantly related to the incidence of lymph node metastasis: 89% (16/18) for undifferentiated carcinomas. However, so-called low-risk tumors had incidence rates of 22% to 47%. Twenty-one patients (13%) presented with clinically apparent cervical lymph node metastasis. Of the 139 patients with clinical N0 neck, 45% had occult neck metastasis. Neck metastasis was found in 29% (10/34) of T1, 54% (38/70) of T2, 65% (20/31) of T3, and 54% (16/25) of T4 tumors. Assessment of survival according to nodal status revealed significant correlations for overall (P<.001) and disease-free survival (P<.001).
We found a high incidence of lymph node metastasis from major salivary gland cancers. Neck dissections should be considered as an integral part of the surgical approach in patients with major salivary gland cancer, especially if no postoperative radiation therapy is planned.
分析大唾液腺癌患者临床明显及隐匿性淋巴结转移的发生率及危险因素。
对患者进行队列研究，中位随访时间为46个月（范围1 - 174个月）。
大学附属医院转诊中心。
共160例连续患者，具备完整的临床和病理资料。
所有病例均行颈部清扫术。患者接受单纯手术治疗（55%）；手术加放射治疗（43%）；或手术、放疗及化疗联合治疗（2%）。
明显及隐匿性淋巴结转移的发生率。采用单因素和多因素分析评估临床及病理资料的意义。
所有病例中53%经组织学证实颈部阳性。组织学诊断与淋巴结转移发生率显著相关：未分化癌为89%（16/18）。然而，所谓的低风险肿瘤发生率为22%至47%。21例患者（13%）出现临床明显的颈部淋巴结转移。在139例临床颈部N0的患者中，45%有隐匿性颈部转移。T1肿瘤患者颈部转移率为29%（10/34），T2为54%（38/70），T3为65%（20/31），T4为54%（16/25）。根据淋巴结状态评估生存率显示，总生存率（P <.001）和无病生存率（P <.001）均有显著相关性。
我们发现大唾液腺癌淋巴结转移发生率较高。颈部清扫术应被视为大唾液腺癌患者手术方法的一个组成部分，尤其是在未计划术后放疗的情况下。
