Shah J P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Am J Surg. 1990 Oct;160(4):405-9. doi: 10.1016/s0002-9610(05)80554-9.
A consecutive series of 1,081 previously untreated patients undergoing 1,119 radical neck dissections (RNDs) for squamous carcinoma of the head and neck was reviewed to study the patterns of nodal metastases. Primary tumors were located in the oral cavity in 501 patients, in the oropharynx in 207 patients, in the hypopharynx in 126 patients, and in the larynx in 247 patients. Lymph node metastases were confirmed histologically in 82% of 776 therapeutic neck dissections, and micrometastases were discovered in 33% of 343 elective RNDs. Lymph node groups in the neck were described by levels (I to V). Predominance of certain levels was seen for each primary site. Levels I, II, and III were at highest risk for metastasis from cancer of the oral cavity, and levels II, III, and IV were at highest risk for metastasis from carcinomas of the oropharynx, hypopharynx, and larynx. Supramohyoid neck dissection (clearing levels I, II, and III) for NO patients with primary squamous cell carcinomas of the oral cavity and anterolateral neck dissection (clearing levels II, III, and IV) for NO patients with primary squamous cell carcinomas of the oropharynx, hypopharynx, and larynx are recommended.
对连续1081例先前未经治疗的患者进行了回顾性研究，这些患者因头颈部鳞状细胞癌接受了1119次根治性颈清扫术（RND），以研究淋巴结转移模式。501例患者的原发肿瘤位于口腔，207例位于口咽，126例位于下咽，247例位于喉。在776例治疗性颈清扫术中，82%经组织学证实有淋巴结转移，在343例选择性RND中，33%发现有微转移。颈部淋巴结组按水平（I至V）描述。每个原发部位都可见某些水平的转移优势。I、II和III水平是口腔癌转移的最高风险区域，II、III和IV水平是口咽、下咽和喉癌转移的最高风险区域。对于口腔原发性鳞状细胞癌的NO患者，建议行颏下颈清扫术（清扫I、II和III水平），对于口咽、下咽和喉原发性鳞状细胞癌的NO患者，建议行颈前外侧清扫术（清扫II、III和IV水平）。
