Fiorella R, Di Nicola V
Istituto di Policattedra di Otorinolaringoiatria, Università di Bari.
Acta Otorhinolaryngol Ital. 1991 Mar-Apr;11(2):103-10.
In laryngeal oncology histological evidence of neoplastic invasion of the latero-cervical lymph nodes (N+) is considered extremely serious in terms of prognosis. To find evidence of metastasis in more than one latero-cervical lymph node is, in fact, not unusual. The purpose of the present work has been to evaluate the clinical and prognostic aspects of multiple latero-cervical metastases in a group of 440 patients suffering from laryngeal carcinoma and who had undergone either total or partial laryngectomy with mono or bilateral lymph node dissection and who had been followed up for at least three years. Of the 440 patients examined 128 (29%) proved histologically N positive and of these 71 (71/128, 55%) showed multiple lymph node metastases, even in those cases of NO. On the average, from a prognostic point of view, the presence of multiple lymph node metastases halved the NED survival rate at three years (38% vs. 65%), clinical staging being equal. In conclusion, in agreement with the literature, the present observations indicate that the number of latero-cervical lymph nodes invaded must be taken into consideration along with the common prognostic factors used in cases of laryngeal carcinoma. In fact, the presence of multiple metastases has a broad, negative affect on survival. Nonetheless, it is not yet possible and is still risky to translate multiple metastases into a preoperative prognosis.
在喉肿瘤学中，从预后角度来看，喉旁颈淋巴结发生肿瘤浸润的组织学证据（N+）被认为极其严重。事实上，在多个喉旁颈淋巴结中发现转移证据并不罕见。本研究的目的是评估一组440例喉癌患者发生多处喉旁颈转移的临床和预后情况。这些患者均接受了全喉或部分喉切除术，并进行了单侧或双侧淋巴结清扫，且随访时间至少为三年。在检查的440例患者中，128例（29%）经组织学检查证实为N阳性，其中71例（71/128，55%）显示有多处淋巴结转移，即使在N0的病例中也是如此。从预后角度平均来看，在临床分期相同的情况下，多处淋巴结转移使三年无病生存率减半（38%对65%）。总之，与文献一致，本研究结果表明，在喉癌病例中，除了常用的预后因素外，还必须考虑喉旁颈淋巴结受侵的数量。事实上，多处转移对生存率有广泛的负面影响。然而，将多处转移转化为术前预后评估目前仍不可行且存在风险。
