Lim Young Chang, Koo Bon Seok, Lee Jin Seok, Lim Jae-Yol, Choi Eun Chang
Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Korea.
Laryngoscope. 2006 Jul;116(7):1148-52. doi: 10.1097/01.mlg.0000217543.40027.1d.
This study sought to investigate the patterns and distributions of lymph node metastases in oropharyngeal squamous cell carcinoma (SCC) and improve the rationale for elective treatment of N0 neck.
One hundred four patients with oropharyngeal SCC who underwent neck dissection between 1992 and 2003 were analyzed retrospectively. All patients had curative surgery as their initial treatment for the primary tumor and neck. A total of 161 neck dissections on both sides of the neck were performed. Therapeutic dissections were done in 71 and 5 necks and elective neck dissection was done on 33 and 52 necks on the ipsilateral and contralateral sides, respectively. Surgical treatment was followed by postoperative radiotherapy for 78 patients. The follow-up period ranged from 1 to 96 months (mean, 30 months).
Of the 161 neck dissection specimens evaluated, 90 (56%) necks were found to have lymph node metastases found by pathologic examination. These consisted of 76 (73% of 104 necks) of the ipsilateral side and 14 (25% of 57 necks) of the contralateral side dissections. The occult metastatic rate was 24% (8 of 33) of ipsilateral neck samples and 21% (11 of 52) of contralateral neck samples. Of the 68 patients who had a therapeutic dissection on the ipsilateral side and had lymphatic metastasis, the incidence rate of level IV and level I metastasis was 37% (25 of 68) and 10% (7 of 68), respectively. Isolated metastasis to level IV occurred on the ipsilateral side in three patients. There were no cases of isolated ipsilateral level I pathologic involvement in an N-positive neck or occult metastasis to this group. The incidence rate of level IV metastasis in patients with ipsilateral nodal metastasis was significantly higher in base of tongue cancer (86% [6 of 7]) compared with tonsillar cancer (34% [20 of 59]) (P=.013). Patients with level IV metastasis had significantly worse 5-year disease-free survival rates than patients with metastasis to other neck levels (54% versus 71%; P=.04).
These results suggest that elective N0 neck treatment in patients with oropharyngeal SCC, especially base of tongue cancer, should include neck levels II, III, and IV instead of levels I, II, and III.
本研究旨在调查口咽鳞状细胞癌（SCC）中淋巴结转移的模式和分布情况，并完善对N0颈部进行选择性治疗的理论依据。
对1992年至2003年间接受颈部清扫术的104例口咽SCC患者进行回顾性分析。所有患者均以根治性手术作为原发肿瘤和颈部的初始治疗。共对双侧颈部进行了161次颈部清扫。71例和5例颈部进行了治疗性清扫，同侧和对侧分别有33例和52例颈部进行了选择性颈部清扫。78例患者术后接受了放疗。随访时间为1至96个月（平均30个月）。
在评估的161份颈部清扫标本中，病理检查发现90例（56%）颈部有淋巴结转移。其中包括同侧76例（104例颈部中的73%）和对侧14例（57例颈部中的25%）清扫标本。同侧颈部标本的隐匿转移率为24%（33例中的8例），对侧颈部标本为21%（52例中的11例）。在同侧进行治疗性清扫且有淋巴转移的68例患者中，IV区和I区转移的发生率分别为37%（68例中的25例）和10%（68例中的7例）。有3例患者同侧出现孤立性IV区转移。在N阳性颈部中，没有同侧I区病理单独受累或该组隐匿转移的病例。舌根癌患者同侧淋巴结转移时IV区转移的发生率（86% [7例中的6例]）显著高于扁桃体癌患者（34% [59例中的20例]）（P = 0.013）。IV区转移患者的5年无病生存率显著低于转移至其他颈部区域的患者（54%对71%；P = 0.04）。
这些结果表明，口咽SCC患者，尤其是舌根癌患者，N0颈部的选择性治疗应包括II、III和IV区，而非I、II和III区。
