原发性腮腺癌是否需要进行Ⅴ级颈清扫术？
Is level V neck dissection necessary in primary parotid cancer?
作者信息
Lim Chwee M, Gilbert Mark, Johnson Jonas T, Kim Seungwon
机构信息
Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, U.S.A; Department of Otolaryngology Head and Neck Surgery, National University Health System, Republic of Singapore.
出版信息
Laryngoscope. 2015 Jan;125(1):118-21. doi: 10.1002/lary.24772. Epub 2014 Jun 26.
OBJECTIVES/HYPOTHESIS: This study aims to evaluate the pattern of nodal metastasis to level V in parotid cancer and to examine the clinical value of level V neck dissection (LVND).
STUDY DESIGN
Retrospective cohort study.
METHODS
Retrospective chart review of 86 patients (47 N0 nodal metastasis [N0] neck and 39 positive nodal metastasis [N(+) ] neck) who received parotidectomy and neck dissection was performed. The prevalence of pathological nodal metastasis in level V neck was evaluated and correlated with locoregional recurrence.
RESULTS
LVND was performed in 10.6% and 28.2% of patients with clinical NO (cN0) and cN(+) neck disease, respectively. The prevalence of pathological positive nodal metastasis was 0% (cN0) and 81.8% (cN(+) ). In patients with cN0 neck, the rate of recurrence in level V was 6%.
CONCLUSION
In our patient cohort with predominantly high-grade parotid cancer, LVND was necessary in patients with cN(+) neck because there was a high likelihood for pathologically positive nodal metastasis. In patients with cN0 neck, the rate of recurrence in level V was low enough not to warrant a routine inclusion of LVND.
目的/假设：本研究旨在评估腮腺癌患者Ⅴ区淋巴结转移模式，并探讨Ⅴ区颈淋巴结清扫术（LVND）的临床价值。
研究设计
回顾性队列研究。
方法
对86例行腮腺切除术和颈淋巴结清扫术的患者（47例颈部淋巴结无转移[N0]，39例颈部淋巴结有转移[N(+)]）进行回顾性病历审查。评估Ⅴ区颈部病理淋巴结转移的发生率，并与局部区域复发相关联。
结果
临床颈部淋巴结无转移（cN0）和临床颈部淋巴结有转移（cN(+)）的患者中，分别有10.6%和28.2%进行了Ⅴ区颈淋巴结清扫术。病理淋巴结转移阳性率在cN0患者中为0%，在cN(+)患者中为81.8%。cN0颈部患者中，Ⅴ区复发率为6%。
结论
在我们以高级别腮腺癌为主的患者队列中，cN(+)颈部患者有必要行Ⅴ区颈淋巴结清扫术，因为病理淋巴结转移阳性的可能性很高。cN0颈部患者中，Ⅴ区复发率足够低，无需常规行Ⅴ区颈淋巴结清扫术。
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