Department of Otolaryngology, Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Poznań, Poland.
Eur Arch Otorhinolaryngol. 2012 Jan;269(1):193-9. doi: 10.1007/s00405-011-1747-z. Epub 2011 Sep 7.
The aim of the study was to examine the impact of positive prelaryngeal node on the outcome of early glottic cancer and to compare the rate of local and regional recurrences and overall survival rates in patients with positive and negative Delphian node (DN). In the years 1989-2008, a consecutive cohort of 212 patients with T1b and T2 glottic cancer with anterior commisure involvement were treated by means of supracricoid partial reconstructive laryngectomies. No adjuvant radiotherapy was administered. Out of 212 patients, in 75 suspected prelaryngeal tissue was found, harvested and separately sent for histological investigation (16-thyroid, 11-fat, 14-connective tissue, 34-lymph nodes). In 137 remaining cases, there were only muscles and fascia without even a small amount of tissue to be taken. In 16 cases out of the whole group, metastases were found. 33 patients with positive ultrasound findings on the lateral neck underwent selective neck dissection; in 4 cases metastases were confirmed. Local and regional recurrence developed in 37 out of 212 patients (17.5%). There was significant correlation between local relapse and prelaryngeal node metastases; out of 20 cases with local recurrence, 13 had positive DN (P < 0.005). There was also significant correlation between nodal relapses and DN metastases; out of 22 cases with nodal relapse, 12 had positive DN and 10 were DN negative (P < 0.005). The organ preservation rates for DN positive and DN negative patients were 62.5 and 93.88%, respectively. There was noted a significant difference in the mean survival between the groups with positive and negative DN (P = 0.004; 38.7 vs. 49.3 months, respectively). In conclusion, positive DN seems to be a strong isolated factor influencing prognosis in patients with early glottic cancer. DN metastases are responsible for the increased rates of local and nodal relapses, decreased chances of organ preservation and poor overall survival rates.
本研究旨在探讨前咽旁淋巴结阳性对早期声门型喉癌治疗效果的影响，并比较 Delphian 淋巴结（DN）阳性和阴性患者的局部和区域复发率以及总生存率。1989 年至 2008 年间，我们对 212 例累及前连合的 T1b 和 T2 声门型喉癌患者连续进行了杓状软骨切除术，所有患者均未接受辅助放疗。在 212 例患者中，75 例疑似有前咽旁组织，采集并单独送检组织学检查（16 例为甲状腺，11 例为脂肪组织，14 例为结缔组织，34 例为淋巴结）。在其余 137 例患者中，只有肌肉和筋膜，甚至没有少量组织可供采集。在整个研究组中，有 16 例发现转移。33 例侧颈部超声检查阳性的患者接受了选择性颈淋巴结清扫术，其中 4 例证实有转移。212 例患者中有 37 例出现局部和区域复发（17.5%）。局部复发与前咽旁淋巴结转移之间存在显著相关性；在 20 例局部复发患者中，13 例有阳性 DN（P<0.005）。淋巴结复发与 DN 转移之间也存在显著相关性；在 22 例淋巴结复发患者中，12 例有阳性 DN，10 例为 DN 阴性（P<0.005）。DN 阳性和 DN 阴性患者的器官保留率分别为 62.5%和 93.88%。两组间的平均生存时间存在显著差异（P=0.004；38.7 个月比 49.3 个月）。综上所述，DN 阳性似乎是影响早期声门型喉癌患者预后的一个独立的重要因素。DN 转移是导致局部和区域复发率增加、器官保留机会减少和总体生存率降低的原因。
