[头颈部鳞状细胞癌患者颈部淋巴结阳性（N1、N2）的选择性颈清扫术]

[Selective neck dissection for node-positive necks (N1, N2) in patients with head and neck squamous cell carcinoma].

作者信息

Tao Ye, Liu Ye-Hai, Yu Chong-Xian, Li Hong-Wu, Zang Yan

机构信息

Department of Otorhinolaryngology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008 Sep;43(9):681-5.

PMID:19035262

Abstract

OBJECTIVE

To evaluate therapeutic effect in a consecutive series of patients with node-positive of N1 and N2 head and neck squamous cell carcinoma (HNSCC) who underwent selective neck dissection as part of their treatment in a single institution.

METHODS

Retrospectively analyzed 36 patients with node positive head and neck squamous cell carcinoma, which had undergone 40 selective neck dissection (SND) and 16 radical neck dissections (RND) and the therapeutic effects of the SND in HNSCC patients with node positive. Kaplan-Meier method was used to estimate the survival analysis among the different levels, and log-rank method for comparison of the different distribution of the several influential factors of the survival; the fisher's exact test was used to test the difference of the neck recurrence between the groups that with or without lymph node extracapsular spread. Cox proportional hazard model was applied to screen the potentially significant prognostic factors.

RESULTS

The 3 and 5 years survival rate of this group were 76.8% and 54.3% retrospectively. The 3 and 5 years' survival rate were both 100% in the N1 + N2a group, while 59.4% and 32.0% in the N2b + N2c group correspondingly. With log-rank test between the two groups above, significant statistical difference was revealed (P = 0.003) in the 5 years' survival rates. To the groups that with or without extracapsular spread (ECS), the recurrence rate were 36.4% and 3.4% respectively and significant statistical difference existed (P = 0.015). In the groups that with or without ECS, the 3 years' survival rate were 45.5% and 81.8% , and 5 years' survival rate were 39.7% and 65.5% respectively, also the significant statistical difference (P = 0.0148 and P = 0.0423 respectively) had presented.

CONCLUSIONS

SND is appropriate for treatment of N1 neck of the patient with HNSCC; However, SND should be taken very cautious to the N2 neck and node-positive neck with extracapsular spread, MRND or RND might be a better choice to prevent the recurrence in the neck.

摘要

目的

评估在单一机构接受选择性颈清扫术作为治疗一部分的一系列连续的N1和N2期头颈鳞状细胞癌（HNSCC）淋巴结阳性患者的治疗效果。

方法

回顾性分析36例淋巴结阳性的头颈鳞状细胞癌患者，这些患者接受了40次选择性颈清扫术（SND）和16次根治性颈清扫术（RND），以及SND对淋巴结阳性HNSCC患者的治疗效果。采用Kaplan-Meier法估计不同水平间的生存分析，采用对数秩检验比较生存的几个影响因素的不同分布；采用Fisher精确检验检验有无淋巴结包膜外扩散组之间颈部复发的差异。应用Cox比例风险模型筛选潜在的显著预后因素。

结果

回顾性分析该组患者3年和5年生存率分别为76.8%和54.3%。N1 + N2a组3年和5年生存率均为100%，而N2b + N2c组相应为59.4%和32.0%。经上述两组间对数秩检验，5年生存率有显著统计学差异（P = 0.003）。对于有无包膜外扩散（ECS）的组，复发率分别为36.4%和3.4%，存在显著统计学差异（P = 0.015）。在有无ECS的组中，3年生存率分别为45.5%和81.8%，5年生存率分别为39.7%和65.5%，也呈现出显著统计学差异（分别为P = 0.0148和P = 0.0423）。