Szewczyk Mateusz, Pazdrowski Jakub, Golusiński Paweł, Dańczak-Pazdrowska Aleksandra, Marszałek Sławomir, Golusiński Wojciech
Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Garbary 15, 61-866, Poznan, Poland,
Eur Arch Otorhinolaryngol. 2015 Oct;272(10):3007-12. doi: 10.1007/s00405-014-3261-6. Epub 2014 Sep 13.
Cutaneous squamous cell carcinoma (cSCC) accounts for 20% of all skin malignancies and 20% of deaths. In contrast to mucosal SCC, treatment results are very good. However, regional metastases are present in 5-20% of cases, and the prognosis for patients with metastases is 50% lower. It has been reported that several risk factors are responsible for the head and neck lymph node regional metastasis, such as: poor cell differentiation, local recurrence, immunosuppression, and tumour dimension. Multivariate analysis of metastatic neck lesions in head and neck cSCC. Retrospective analysis of patients treated at our department for head and neck cSCC. The study includes 100 patients: 66 males (66%) and 34 females (34%), aged 26-98 years (mean age 74.6). The tumour was evaluated for: sex predilection, local recurrence, stage (according to 7th edition of American Joint Committee on Cancer TNM staging), differentiation, and site. Most patients (79 cases; 79%) were treated for primary cSCC, while the other 21 patients presented local recurrence of cSCC. Neck metastases were diagnosed in five patients with primary cSCC and in three with recurrent cSCC. No distant metastasis was observed. The most common tumour location was the auricle (29 cases; 29%). Neck dissection was performed most frequently in patients with lip tumours (17/22 cases; 77%). Neck metastasis was diagnosed most often in patients with cSCC on the lip (2 patients) and buccal region (2 patients). The most common tumour location in males was the auricle (25/66 cases; 38%) whereas in females the nasal and buccal regions were the most common locations, with 8 patients each (8/34 cases; 23%). Neck dissection was performed in 20 of the 66 males (30%) and in 12 of the 34 females (35%). Neck metastasis was confirmed in 5 females (15%) and 3 males (5%). The most common histopathological tumour stage was G2 (57 cases; 57%). Of the eight patients with confirmed neck metastasis, four had poorly-differentiated (histopathological stage G3). Thus, 4 of the 24 patients (17%) with stage G3 tumours experienced metastasis. Our findings suggest that factors such as local recurrence, degree of cell differentiation, tumour dimension and/or location, can increase the risk of neck metastases. For this reason, in patients with such risk factors, neck dissection should be considered to evaluate for metastatic lesions.
皮肤鳞状细胞癌（cSCC）占所有皮肤恶性肿瘤的20%，且导致20%的死亡病例。与黏膜鳞状细胞癌不同，其治疗效果非常好。然而，5%-20%的病例存在区域转移，发生转移的患者预后降低50%。据报道，几个风险因素与头颈部淋巴结区域转移有关，如：细胞分化差、局部复发、免疫抑制和肿瘤大小。头颈部cSCC颈部转移病变的多因素分析。对在我科接受治疗的头颈部cSCC患者进行回顾性分析。该研究纳入100例患者：66例男性（66%）和34例女性（34%），年龄26-98岁（平均年龄74.6岁）。对肿瘤进行了如下评估：性别倾向、局部复发、分期（根据美国癌症联合委员会第7版TNM分期）、分化程度和部位。大多数患者（79例；79%）接受原发性cSCC治疗，而其他21例患者表现为cSCC局部复发。5例原发性cSCC患者和3例复发性cSCC患者被诊断为颈部转移。未观察到远处转移。最常见的肿瘤部位是耳廓（29例；29%）。唇部肿瘤患者最常进行颈部清扫术（17/22例；77%）。唇部（2例）和颊部（2例）cSCC患者最常被诊断为颈部转移。男性最常见的肿瘤部位是耳廓（25/66例；38%），而女性最常见的部位是鼻和颊部，各有8例患者（8/34例；23%）。66例男性中有20例（30%）进行了颈部清扫术，34例女性中有12例（35%）进行了颈部清扫术。5例女性（15%）和3例男性（5%）被确诊为颈部转移。最常见的组织病理学肿瘤分期为G2（57例；57%）。在8例确诊颈部转移的患者中，4例为低分化（组织病理学分期G3）。因此，24例G3期肿瘤患者中有4例（17%）发生了转移。我们的研究结果表明，局部复发、细胞分化程度、肿瘤大小和/或部位等因素可增加颈部转移的风险。因此，对于有这些风险因素的患者，应考虑进行颈部清扫术以评估是否存在转移病变。
