Dias Fernando L, Lima Roberto A, Kligerman Jacob, Farias Terence P, Soares Jose Roberto N, Manfro Gabriel, Sa Geraldo M
Department of Head and Neck Surgery, Brazilian National Cancer Institute, Av. Alexandre Ferreira 190, Rio de Janeiro, RJ 22470-220, Brazil.
Otolaryngol Head Neck Surg. 2006 Mar;134(3):460-5. doi: 10.1016/j.otohns.2005.09.025.
To analyze the therapeutic implications of the distribution of neck metastases (NM) in patients with squamous cell carcinoma (SCC) of the tongue and the floor of the mouth (FOM).
From January 1987 through December 1997, 339 previously untreated patients with T1-2 N0 M0 SCC of the tongue and the FOM underwent primary surgical treatment in our institution. A retrospective review of the pathology reports and outcome of these patients was made to ascertain the prevalence and distribution of NM. Patients were grouped by clinical neck status at the time of neck dissection: elective neck dissection (END) in the NO neck and subsequent therapeutic dissection (STD) in the neck observed which converted clinically to N+ or regional recurrences after END. All patients were classified according to the American Joint Committee on Cancer (AJCC)/UICC 2002 TNM classification.
All patients underwent surgical treatment of the primary cancer and had negative margins at frozen section. Overall incidence of NM was 41.3%. Twenty-seven point eight percent of T1 N0 M0 and 48.2% of T2 N0 M0 patients developed NM (P = .0004). Occult neck metastases occurred in 24.1% of patients. Clinically, N+ metastases occurred in 23.6% of patients. The overall incidence of NM in levels IV and V was 8.5%. Neck level IV nodes were involved in only 1.5% of patients in the END group versus 23.7% in the STD group (P < 0.001). Level V was always associated to nodal metastases in other neck levels. Only 2% of patients in our study presented "skip metastases" in the neck.
Neck levels I and II were at great risk for the development of NM (46.9% and 75.3% respectively). Levels IV (6.5%) and V (2%) were rarely involved in our group of patients. The results found in this study support the indication of supraomohyoid neck dissection for N0 and a more comprehensive neck dissection (levels I-V) for N+ patients in Stage I-II SCC of the tongue and FOM.
C-4.
分析舌癌和口底鳞状细胞癌患者颈部转移瘤（NM）分布的治疗意义。
1987年1月至1997年12月，339例未经治疗的T1-2 N0 M0舌癌和口底鳞状细胞癌患者在我院接受了原发手术治疗。对这些患者的病理报告和治疗结果进行回顾性分析，以确定颈部转移瘤的发生率和分布情况。根据颈部清扫时的临床颈部状况对患者进行分组：NO颈部的择区颈部清扫（END），以及对END后临床上转为N+或区域复发的颈部进行后续治疗性清扫（STD）。所有患者均按照美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）2002年TNM分类进行分类。
所有患者均接受了原发癌的手术治疗，冰冻切片切缘阴性。颈部转移瘤的总体发生率为41.3%。T1 N0 M0患者中27.8%发生颈部转移瘤，T2 N0 M0患者中48.2%发生颈部转移瘤（P = 0.0004）。隐匿性颈部转移瘤在24.1%的患者中出现。临床上，23.6%的患者发生N+转移。IV和V区颈部转移瘤的总体发生率为8.5%。END组仅1.5%的患者IV区颈部淋巴结受累，而STD组为23.7%（P < 0.001）。V区总是与其他颈部区域的淋巴结转移相关。本研究中仅2%的患者出现颈部“跳跃转移”。
I区和II区颈部发生颈部转移瘤的风险很高（分别为46.9%和75.3%）。IV区（6.5%）和V区（共2%）在我们的患者组中很少受累。本研究结果支持对于I-II期舌癌和口底鳞状细胞癌N0患者行肩胛舌骨上颈部清扫，对于N+患者行更全面的颈部清扫（I-V区）。
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