Coster J R, Foote R L, Olsen K D, Jack S M, Schaid D J, DeSanto L W
Mayo Clinic, Rochester, MN 55905.
Int J Radiat Oncol Biol Phys. 1992;23(4):743-9. doi: 10.1016/0360-3016(92)90647-z.
The records of patients with pathologically confirmed metastatic squamous cell carcinoma involving cervical lymph nodes who were treated at the Mayo Clinic between January 1965 and December 1987 were reviewed. In 117 patients a primary tumor could not be discovered. Of these, 24 patients underwent curative resection of all gross disease by neck dissection or excisional biopsy. All 24 patients presented with unilateral adenopathy. Their median age was 63 years. Eighteen patients were men. Fourteen patients were in clinical stage N1; six, N2a; three, N2b; and one, N3. Six patients had grade 1 or 2 nodal metastases; 14, grade 3; and 4, grade 4. Gross or microscopic evidence of extracapsular tumor extension was noted in eight patients. All patients were followed until death or for a median of 8.5 years (range, 3.3-20.4 years). A squamous cell carcinoma of the upper aerodigestive tract subsequently developed in only one patient (4%) within 5 years of operation. In six patients (25%), a recurrence developed in the dissected neck a median of 3 months (2.4 months-6.6 years) after operation. Five of these patients had extracapsular extension, and four had pathologic Stage N2a or higher neck disease. Both patients with pathologic Stage N1 disease who had recurrences in the dissected neck had extracapsular extension. Delayed, contralateral neck metastases in an undissected neck developed in two patients. The 5-year overall and cause-specific survivals for all 24 patients were 66% and 74%, respectively. Extracapsular extension was a predictor of neck recurrence, control of disease above the clavicles, cause-specific survival, and overall survival. Patients with pathologic Stage N1 neck disease with no extracapsular extension can be managed by surgery alone. Patients with pathologic Stage N2 or higher neck disease or extracapsular extension should be considered for postoperative, adjuvant radiation therapy.
回顾了1965年1月至1987年12月在梅奥诊所接受治疗的经病理证实为累及颈部淋巴结的转移性鳞状细胞癌患者的记录。117例患者未发现原发性肿瘤。其中，24例患者通过颈部清扫术或切除活检对所有肉眼可见病变进行了根治性切除。所有24例患者均表现为单侧腺病。他们的中位年龄为63岁。18例为男性。14例患者处于临床N1期；6例为N2a期；3例为N2b期；1例为N3期。6例患者有1级或2级淋巴结转移；14例为3级；4例为4级。8例患者有肿瘤包膜外扩展的大体或显微镜证据。所有患者均随访至死亡或中位随访8.5年（范围3.3 - 20.4年）。仅1例患者（4%）在术后5年内随后发生上呼吸消化道鳞状细胞癌。6例患者（25%）在术后中位3个月（2.4个月 - 6.6年）在清扫的颈部出现复发。这些患者中有5例有包膜外扩展，4例有病理N2a期或更高分期的颈部疾病。在清扫的颈部复发的2例病理N1期疾病患者均有包膜外扩展。2例患者在未清扫的颈部出现延迟的对侧颈部转移。所有24例患者的5年总生存率和病因特异性生存率分别为66%和74%。包膜外扩展是颈部复发、锁骨上疾病控制、病因特异性生存和总生存的预测因素。无包膜外扩展的病理N1期颈部疾病患者可仅通过手术治疗。病理N2期或更高分期的颈部疾病或有包膜外扩展的患者应考虑术后辅助放疗。
