Jose Jemy, Moor James W, Coatesworth Andrew P, Johnston Colin, MacLennan Ken
Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary, Leeds, England.
Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):157-60. doi: 10.1001/archotol.130.2.157.
Soft tissue deposits of squamous cell carcinoma in the necks of patients with squamous cell carcinoma of the upper aerodigestive tract may represent either total effacement of a lymph node by carcinoma or extralymphatic deposits of carcinoma. There are few reports of their clinical or prognostic significance.
Data from 215 neck dissections from 155 patients with squamous cell carcinoma of the upper aerodigestive tract were studied prospectively to assess the prevalence of soft tissue deposits within the neck. The case notes of these patients were subsequently reviewed to analyze the effect on both the overall survival and recurrence-free survival.
The prevalence rate for soft tissue deposits occurring alone was 10.3%; the prevalence rate for soft tissue deposits occurring with extracapsular spread was 13.5%. The overall prevalence rate for soft tissue deposits was 23.9%. There was a statistically significant reduction in actuarial and recurrence-free survival in patients with soft tissue deposits compared with patients with pathologically node-negative necks (P=.001), and in patients with soft tissue deposits compared with those with pathologically node-positive necks without extracapsular spread (P=.001). No statistically significant differences were found between patients with soft tissue deposits and patients with pathologically node-positive necks with extracapsular spread, for actuarial survival or recurrence-free survival.
In this series, soft tissue deposits were associated with an aggressive clinical course and poor survival. It is therefore important that histopathologists agree on a uniform terminology when reporting soft tissue deposits and actively look for their presence when examining neck dissection specimens.
上消化道鳞状细胞癌患者颈部的鳞状细胞癌软组织沉积物可能代表癌组织对淋巴结的完全取代，也可能是癌组织的淋巴结外沉积。关于其临床或预后意义的报道较少。
前瞻性研究了155例上消化道鳞状细胞癌患者的215例颈部清扫数据，以评估颈部软组织沉积物的患病率。随后回顾了这些患者的病历，以分析对总生存期和无复发生存期的影响。
单独出现软组织沉积物的患病率为10.3%；伴有包膜外扩散的软组织沉积物患病率为13.5%。软组织沉积物的总体患病率为23.9%。与病理检查淋巴结阴性的患者相比，有软组织沉积物的患者的精算生存率和无复发生存率有统计学显著降低（P = 0.001）；与病理检查淋巴结阳性但无包膜外扩散的患者相比，有软组织沉积物的患者也有统计学显著降低（P = 0.001）。对于精算生存率或无复发生存率，有软组织沉积物的患者与病理检查淋巴结阳性且有包膜外扩散的患者之间未发现统计学显著差异。
在本系列研究中，软组织沉积物与侵袭性临床病程和较差的生存率相关。因此，重要的是组织病理学家在报告软组织沉积物时应就统一的术语达成一致，并在检查颈部清扫标本时积极寻找其存在。
