Ali Safina, Palmer Frank L, DiLorenzo Monica, Shah Jatin P, Patel Snehal G, Ganly Ian
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2014 Sep;21(9):3042-8. doi: 10.1245/s10434-014-3681-y. Epub 2014 Apr 10.
To review our experience in the treatment of the neck in patients with carcinoma of the parotid gland.
A total of 263 patients were stratified into 3 groups: no neck dissection (NoND), elective neck dissection (END), and therapeutic neck dissection (TND). Clinicopathological characteristics of END and TND versus NoND were compared by Chi square test. Pathological positivity of each neck level was quantified. Neck recurrence-free survival was determined by Kaplan-Meier statistics.
There were 232 cN0 and 31 cN+ patients. Of the cN0 patients, 74 had END. All cN+ patients had TND. Of the END group, occult neck metastases were detected in 26 (35 %) patients. The percentage of positivity was 6.7, 28.3, 21.3, 10.8, and 6.7 % for levels I to V, respectively. Compared to the NoND group, the END group was more likely to be over 60 years old, to have cT3T4 disease, and to have disease with more aggressive histology. Of the TND group, pathological positivity was found in 87 %. The percentage of positivity was 51.6, 77, 73, 53, and 40 % for levels I to V, respectively. Patients who had disease-positive necks had a poorer neck recurrence-free survival of 84.8 %.
In patients with cN0 disease, observation of the neck is safe in those who are under 60 years of age with clinical T1 or T2 tumors and who have low-grade histology. END should be carried out in patients with cT3T4 disease or high-grade histology and should involve levels II to IV at a minimum. Patients with cN+ disease commonly have all neck levels involved and therefore should be managed with comprehensive neck dissection.
回顾我们在腮腺癌患者颈部治疗方面的经验。
总共263例患者被分为3组：未行颈部清扫术（NoND）、选择性颈部清扫术（END）和治疗性颈部清扫术（TND）。通过卡方检验比较END和TND与NoND的临床病理特征。对每个颈部水平的病理阳性情况进行量化。采用Kaplan-Meier统计方法确定颈部无复发生存率。
有232例cN0患者和31例cN+患者。在cN0患者中，74例行END。所有cN+患者均行TND。在END组中，26例（35%）患者检测到隐匿性颈部转移。I至V级的阳性率分别为6.7%、28.3%、21.3%、10.8%和6.7%。与NoND组相比，END组患者更可能年龄超过60岁、患有cT3T4期疾病且组织学表现更具侵袭性。在TND组中，87%发现病理阳性。I至V级的阳性率分别为51.6%、77%、73%、53%和40%。颈部有疾病阳性的患者颈部无复发生存率较差，为84.8%。
对于cN0期疾病患者，年龄小于60岁、临床T1或T2肿瘤且组织学分级低的患者观察颈部是安全的。cT3T4期疾病或组织学分级高的患者应行END，且至少应包括II至IV级。cN+期疾病患者通常所有颈部水平均受累，因此应行根治性颈部清扫术。
