颈清扫术中保留颈内静脉对头颈部癌症的预后作用。

Prognostic role of internal jugular vein preservation in neck dissection for head and neck cancer.

机构信息

Academic Clinic of Otolaryngology and Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.

出版信息

J Surg Oncol. 2013 Dec;108(8):579-83. doi: 10.1002/jso.23436. Epub 2013 Oct 24.

DOI:10.1002/jso.23436

PMID:24155132

Abstract

BACKGROUND AND OBJECTIVES

Sparing internal jugular vein (IJV) in neck dissection for head and neck cancer is controversial. We aimed at evaluating the prognostic impact of IJV preservation.

METHODS

We examined 206 files of head and neck cancer patients who underwent radical or modified radical neck dissection at the Otolaryngology University of Florence. The site of primary tumor was larynx and hypopharynx in 44.66%, oropharynx in 25.24%, oral cavity in 23.3%, unknown in 4.85%, salivary glands and rhinopharynx in 0.97%. In 60.19% the IJV was resected, in 39.81% preserved. Prognostic impact of IJV preservation was assessed by Kaplan-Meier and multivariate analysis.

RESULTS

Neck recurrence occurred in 25.2%: the IJV was resected in 42.31%, in 57.69% preserved (P = 0.02). At multivariate analysis, neck recurrence resulted significantly associated to extracapsular spread (ECS) (P = 0.009), IJV preservation (P = 0.01), positive margins (P = 0.02). In ECS positive patients, a higher risk of neck recurrence was documented for IJV preservation (P = 0.012). A worse prognosis was observed for patients with IJV spared (P = 0.06).

CONCLUSIONS

IJV preservation is associated with an increased risk of neck failure and a worse outcome, mainly in patients with ECS of nodes.

摘要

背景与目的

在头颈部癌症的颈清扫术中保留颈内静脉（IJV）存在争议。我们旨在评估 IJV 保留对预后的影响。

方法

我们检查了在佛罗伦萨大学耳鼻喉科接受根治性或改良根治性颈清扫术的 206 例头颈部癌症患者的档案。原发肿瘤部位为：喉和下咽 44.66%，口咽 25.24%，口腔 23.3%，不明原发灶 4.85%，唾液腺和鼻咽 0.97%。60.19%的患者切除了 IJV，39.81%保留了 IJV。通过 Kaplan-Meier 和多因素分析评估 IJV 保留的预后影响。

结果

25.2%的患者发生颈部复发：42.31%的患者切除了 IJV，57.69%的患者保留了 IJV（P=0.02）。多因素分析显示，颈部复发与包膜外扩散（ECS）（P=0.009）、IJV 保留（P=0.01）、阳性切缘（P=0.02）显著相关。在 ECS 阳性的患者中，保留 IJV 与更高的颈部复发风险相关（P=0.012）。保留 IJV 的患者预后较差（P=0.06）。