Lau Valerie H, Aouad Rony, Farwell D Gregory, Donald Paul J, Chen Allen M
Department of Radiation Oncology, University of California - Davis School of Medicine, Sacramento, California.
Head Neck. 2014 Oct;36(10):1435-9. doi: 10.1002/hed.23467. Epub 2014 Jan 13.
The purpose of this study was to analyze the pattern of occult cervical lymph node metastasis among patients with clinically N0 salivary gland carcinoma.
One hundred nineteen patients underwent primary surgery and ipsilateral neck dissection for clinically N0 carcinomas of the major and minor salivary glands. Eighty patients (67%) had parotid tumors. Distribution of T classification was: T1 (18%), T2 (28%), T3 (23%), and T4 (32%).
Twenty-five patients (21%) had pathological cervical disease. The incidence was highest among patients with adenocarcinoma (35%) and high-grade mucoepidermoid carcinoma (35%). The most common site of cervical lymph node metastasis was level II (71%), followed by level III (15%), and level IB (8%). On multivariate analysis, histological subtype was independently predictive of occult pathological lymph node metastasis (p < .001).
The likelihood of occult cervical lymph node metastasis for patients with salivary gland carcinoma is driven predominantly by histological subtype. Implications for elective neck irradiation are discussed.
本研究旨在分析临床N0期涎腺癌患者隐匿性颈淋巴结转移的模式。
119例临床N0期大、小涎腺癌患者接受了原发灶手术及同侧颈淋巴结清扫术。80例（67%）患者患有腮腺肿瘤。T分期分布为：T1（18%）、T2（28%）、T3（23%）和T4（32%）。
25例（21%）患者存在病理性颈部病变。腺癌（35%）和高级别黏液表皮样癌（35%）患者的发病率最高。颈淋巴结转移最常见的部位是Ⅱ区（71%），其次是Ⅲ区（15%）和ⅠB区（8%）。多因素分析显示，组织学亚型是隐匿性病理性淋巴结转移的独立预测因素（p <.001）。
涎腺癌患者隐匿性颈淋巴结转移的可能性主要由组织学亚型决定。讨论了选择性颈部放疗的意义。
