Li X Y, Li J R, Guo H G
Department of Otolaryngology Head and Neck Surgery, Navy General Hospital, Beijing,100048, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Dec 5;31(23):1793-1796. doi: 10.13201/j.issn.1001-1781.2017.23.003.
To evaluate the efficacy and safety of regional neck dissection in the treatment of cN0 laryngeal carcinoma with positive cervical lymph node. A retrospective analysis of 120 cases with cN0 laryngeal squamous cell carcinoma who received the first time for primary tumor resection and regional neck dissection (Ⅱ-Ⅳ) in our hospital during the period of 2000.01-2016.06 were performed. Twenty-two patients with lymph node positive (pN+) were selected by postoperative paraffin pathology in Ⅱ-Ⅳ region and followed up to 2017.06. The recurrence rate, survival rate and survival related regression analysis of patients with stage cN0 pN+ laryngeal carcinoma were analyzed. The cN0 laryngeal cancer occult metastasis rate was 18.33% (22/120) in regional neck dissection. Local recurrence, regional recurrence, distant metastasis rates of 3 and 5 years were 41.18%, 17.65%, 17.65% and 40.00%, 13.33%, 20.00%, respectively in cN0 pN+ patients. The overall survival rates of 3 and 5 years were 61.2% and 30.6% respectively, and the disease-free survival rate was 31.8% and 22.7%. There was no significant difference in overall and disease-free survival between the T staging or clinical classification (>0.05). Cox regression analysis showed that overall survival was related to age and local-regional (=11.421, =0.001, =5.211, =0.022). Logistic multivariate regression analysis showed that local-regional recurrence was not related to each factor (>0.05). Local recurrence rate and mortality rate of cN0 pN+ laryngeal carcinoma are higher, survival rate is lower, however, neck recurrence rate is low.Therefore, Ⅱ-Ⅳ neck dissection is a safe and effective treatment for neck of cN0 pN+ laryngeal carcinoma.
评估区域性颈部清扫术治疗cN0期喉癌伴颈部淋巴结阳性的疗效及安全性。对2000年1月至2016年6月期间在我院首次接受原发性肿瘤切除及区域性颈部清扫术（Ⅱ-Ⅳ区）的120例cN0期喉鳞状细胞癌患者进行回顾性分析。术后经Ⅱ-Ⅳ区石蜡病理检查筛选出22例淋巴结阳性（pN+）患者，随访至2017年6月。分析cN0 pN+期喉癌患者的复发率、生存率及生存相关回归分析。区域性颈部清扫术中cN0期喉癌隐匿转移率为18.33%（22/120）。cN0 pN+患者3年和5年的局部复发率、区域复发率、远处转移率分别为41.18%、17.65%、17.65%和40.00%、13.33%、20.00%。3年和5年总生存率分别为61.2%和30.6%，无病生存率分别为31.8%和22.7%。T分期或临床分类之间的总生存和无病生存无显著差异（>0.05）。Cox回归分析显示总生存与年龄及局部-区域有关（=11.421，=0.001，=5.211，=0.022）。Logistic多因素回归分析显示局部-区域复发与各因素无关（>0.05）。cN0 pN+期喉癌局部复发率和死亡率较高，生存率较低，颈部复发率较低。因此，Ⅱ-Ⅳ区颈部清扫术是治疗cN0 pN+期喉癌颈部的一种安全有效的方法。
