Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain.
Head Neck. 2012 Jun;34(6):771-5. doi: 10.1002/hed.21804. Epub 2011 Jul 7.
The recognition of patients at high risk for the development of distant metastasis (DM) is required to recognize a subset of patients who may benefit from systemic therapy.
In a retrospective analysis of patients treated between 1995 and 2006, 443 patients with surgically treated primary head and neck squamous cell carcinoma were included. The frequency and clinicopathologic risk factors for DM were evaluated.
A total of 60 patients (13.5%) developed DM. In a univariate analysis, tumor site (pharynx), pN classification (pN2-N3), differentiation grade (poorly differentiated), disease stage (stage IV), number (3 or more nodes), and site (bilateral nodes) of nodal metastasis were found to be significantly associated with the risk of DM. In a multivariate analysis, the only significant risk factors were the differentiation grade and the number and site of nodal metastasis.
Patients with pharyngeal poorly differentiated tumors, with multiple or bilateral nodal metastases, are at greater risk of DM and should be considered for systemic therapy.
需要识别出可能受益于全身治疗的患者亚群，以识别出有远处转移（DM）发展高风险的患者。
在对 1995 年至 2006 年间治疗的患者进行的回顾性分析中，纳入了 443 例接受手术治疗的原发性头颈部鳞状细胞癌患者。评估了 DM 的频率和临床病理危险因素。
共有 60 例患者（13.5%）发生 DM。单因素分析显示，肿瘤部位（咽）、pN 分类（pN2-N3）、分化程度（低分化）、疾病分期（IV 期）、淋巴结转移数量（3 个或更多淋巴结）和部位（双侧淋巴结）与 DM 的风险显著相关。多因素分析显示，唯一的显著危险因素是分化程度和淋巴结转移的数量和部位。
患有咽部低分化肿瘤、多个或双侧淋巴结转移的患者，发生 DM 的风险更高，应考虑全身治疗。
