Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Surg Oncol. 2012 Sep 15;106(4):475-80. doi: 10.1002/jso.23100. Epub 2012 Mar 27.
Little is known about lymph node metastasis and the extent of neck dissection (ND) in patients with submandibular gland (SMG) carcinoma. We therefore evaluated the metastatic topography of neck lymph nodes in patients with SMG carcinoma and the influence of metastases on tumor recurrence and patient survival.
The pattern of lymph node spread was analyzed in 64 patients with SMG carcinoma treated from January 1994 to January 2009. Disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) were calculated, and the clinicopathological factors associated with each were analyzed.
Positive pathological lymph nodes were detected in 31 (48.4%) patients and was found to correlate significantly with histologic grade (P<0.001) on univariate analysis. Eight patients (19.5%) had occult cervical metastases. The 5-year DFS, OS, and DMFS rates were 46.8, 56.2, and 58.5%, respectively, and 23 patients (35.9%) experienced systemic failure. Multivariate analyses revealed that T-classification (P=0.043) and N-classification (P=0.006) were significantly independent predictors of DFS, whereas only N-classification (P=0.049) was significantly associated with DMFS.
Elective ND should be recommended for preoperatively suspected high-grade malignancy in SMG carcinoma. Patients with nodal metastasis should receive more effective therapy to hinder recurrence and distant metastasis.
关于颌下腺癌的淋巴结转移和颈部清扫术（ND）范围，目前知之甚少。因此，我们评估了颌下腺癌患者颈部淋巴结转移的分布模式，以及转移对肿瘤复发和患者生存的影响。
分析了 1994 年 1 月至 2009 年 1 月期间治疗的 64 例颌下腺癌患者的淋巴结转移模式。计算了无病生存率（DFS）、总生存率（OS）和无远处转移生存率（DMFS），并分析了与每种情况相关的临床病理因素。
31 例（48.4%）患者的病理淋巴结阳性，单因素分析显示其与组织学分级显著相关（P<0.001）。8 例（19.5%）患者存在隐匿性颈部转移。5 年 DFS、OS 和 DMFS 率分别为 46.8%、56.2%和 58.5%，23 例（35.9%）患者出现全身失败。多因素分析显示 T 分期（P=0.043）和 N 分期（P=0.006）是 DFS 的显著独立预测因素，而仅 N 分期（P=0.049）与 DMFS 显著相关。
对于术前疑似恶性程度高的颌下腺癌，应推荐选择性 ND。有淋巴结转移的患者应接受更有效的治疗，以阻止复发和远处转移。
