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需要多少个节点来分期颈部?一项批判性评价。

How many nodes are needed to stage a neck? A critical appraisal.

机构信息

Department of Head and Neck Surgery, Otolaryngology, Hospital A C Camargo, Rua Santana, 142 sala 42/43, 18130-555 São Roque, SP, Brazil.

出版信息

Eur Arch Otorhinolaryngol. 2010 May;267(5):785-91. doi: 10.1007/s00405-009-1144-z. Epub 2009 Nov 11.

Abstract

Reliable staging of the neck is an important factor for the estimation of prognosis of head and neck cancer patients. A total of 608 patients with oral squamous cell carcinomas treated from March 1975 to December 2000 were enrolled. In radical neck dissection (RND) group, the number of lymph nodes ranged from 6 to 116; while in selective neck dissection (SND) group, from 1 to 87 (P < 0.001). In SND group, the number of metastatic nodes ranged from 0 to 8 nodes, while in RND group, from 0 to 47 (P < 0.001). The number of dissected lymph nodes correlates with the presence of positive nodes (P = 0.001). In RND group, this correlation is described by the equation Y = -0.0117X (2) + 1.7262X. Factors affecting neck metastasis were number of dissected nodes (P < 0.001), lymphatic embolization (P = 0.044) and neural invasion (P = 0.030). In SND group, this equation is Y = -0.012X (2) + 1.5102X; the number of dissected nodes (P = 0.002) and lymphatic embolization (P = 0.001) were significant for metastasis finding. For patients with tumors at stages I and II, a significant impact on survival and neck recurrence rates were observed. In conclusion, we report the importance of the number of retrieved nodes in likelihood of positive cervical node finding. Node yield is an important factor in oral cancer staging, and, more important, in early stage carcinomas, it is associated with survival and recurrence rates.

摘要

对颈部进行可靠分期是评估头颈部癌症患者预后的重要因素。共有 608 例口腔鳞状细胞癌患者于 1975 年 3 月至 2000 年 12 月接受治疗。在根治性颈清扫术(RND)组中,淋巴结数量从 6 个到 116 个不等;而在选择性颈清扫术(SND)组中,淋巴结数量从 1 个到 87 个不等(P<0.001)。在 SND 组中,转移淋巴结的数量从 0 个到 8 个不等,而在 RND 组中,从 0 个到 47 个不等(P<0.001)。清扫的淋巴结数量与阳性淋巴结的存在相关(P=0.001)。在 RND 组中,这种相关性由方程 Y=-0.0117X(2)+1.7262X 描述。影响颈部转移的因素包括清扫的淋巴结数量(P<0.001)、淋巴栓塞(P=0.044)和神经侵犯(P=0.030)。在 SND 组中,这个方程是 Y=-0.012X(2)+1.5102X;清扫的淋巴结数量(P=0.002)和淋巴栓塞(P=0.001)是转移发现的显著因素。对于肿瘤处于 I 期和 II 期的患者,生存和颈部复发率受到显著影响。总之,我们报告了在颈淋巴结阳性发现的可能性中检索到的淋巴结数量的重要性。淋巴结产量是口腔癌分期的一个重要因素,更重要的是,在早期癌症中,它与生存率和复发率相关。

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