Matsuo Jeannette Marie S, Patel Snehal G, Singh Bhuvanesh, Wong Richard J, Boyle Jay O, Kraus Dennis H, Shaha Ashok R, Zelefsky Michael J, Pfister David G, Shah Jatin P
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Ann Surg. 2003 Sep;238(3):412-21; discussion 421-2. doi: 10.1097/01.sla.0000086660.35809.8a.
To determine the impact of clinical nodal stage on distant metastasis (DM) in patients with squamous cell carcinoma of the larynx (SCCL).
Six hundred sixty-two previously untreated SCCL patients treated at a tertiary care cancer center from January 1984 to December 1998 were eligible for analysis. The end point of interest was development of DM following treatment. Distant metastasis-free survival (DMFS) was calculated by the Kaplan-Meier method; predictors of outcome were identified by univariate and multivariate analysis. The primary tumor site was glottic in 55%, supraglottic in 40%, and trans/sub glottic in 5%; 40% had locoregionally advanced (stage III/IV) tumors. At initial presentation, 25% of patients (12% N1, 11% N2, and 2% N3) had clinically metastatic nodes.
DM were recorded in 67 patients (10%; lung, 45%; soft tissue, 13%; bone, 10%; multiple sites, 28%). The median time to DM was 18 months (range, 1-109). With a median follow-up of 60 months, the 5-year DMFS was 88%. Even after accounting for the type of index treatment, the only significant predictor of worse DMFS on multivariate analysis was a higher clinical N stage (P < 0.0001). The relative risk for DM was 0.5 (95% CI, 0.2-1.4; P = NS) for cN1, 3.2 (95% CI, 1.7-5.9; P < 0.0001) for cN2, and 7.5 (95% CI, 3.1-17.9; P < 0.0001) for cN3 disease compared with clinically N0 patients.
Regardless of the index treatment modality, primary tumor site, or T stage, a higher clinical N stage at the time of presentation independently and significantly increases the risk of DM in patients with SCCL.
确定临床淋巴结分期对喉鳞状细胞癌（SCCL）患者远处转移（DM）的影响。
1984年1月至1998年12月在一家三级癌症中心接受治疗的662例未经治疗的SCCL患者符合分析条件。感兴趣的终点是治疗后发生DM。采用Kaplan-Meier法计算无远处转移生存期（DMFS）；通过单因素和多因素分析确定预后的预测因素。原发肿瘤部位声门型占55%，声门上型占40%，声门下/跨声门型占5%；40%的患者有局部晚期（III/IV期）肿瘤。初诊时，25%的患者（N1占12%，N2占11%，N3占2%）有临床转移淋巴结。
67例患者（10%）出现DM（肺转移占45%，软组织转移占13%，骨转移占10%，多部位转移占28%）。发生DM的中位时间为18个月（范围1 - 109个月）。中位随访60个月，5年DMFS为88%。即使在考虑了初始治疗类型后，多因素分析中唯一显著预测DMFS较差的因素是临床N分期较高（P < 0.0001）。与临床N0患者相比，cN1患者发生DM的相对风险为0.5（95%CI，0.2 - 1.4；P = 无统计学意义），cN2患者为3.2（95%CI，1.7 - 5.9；P < 0.0001），cN3患者为7.5（95%CI，3.1 - 17.9；P < 0.0001）。
无论初始治疗方式、原发肿瘤部位或T分期如何，初诊时较高的临床N分期会独立且显著增加SCCL患者发生DM的风险。
