Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Int J Clin Oncol. 2019 Jun;24(6):624-631. doi: 10.1007/s10147-019-01411-3. Epub 2019 Feb 9.
There is no consensus about the indications and range of neck dissection in patients who have parotid carcinoma, with elective neck dissection for cN0 disease being particularly controversial.
This study retrospectively reviewed 185 patients with newly diagnosed parotid carcinoma who were treated at our department between September 1999 and August 2018.
50 of the 185 patients had lymph node metastasis, including 7.7%, 12.2%, 36.0%, and 55.8% of patients with T1, T2, T3, and T4 disease, respectively. When classified by histological grade, 5.7% of patients with low/intermediate-grade disease had lymph node metastasis versus 55.0% of patients with high-grade disease. Multivariate analysis revealed that the histological grade and T classification were independent predictors of lymph node metastasis. Occult metastasis was found in 8 out of 73 clinically node negative patients undergoing neck dissection. The most common site of cervical metastasis was level 2, followed by the periparotid nodes, level 3, and level 4.
Elective neck dissection may be most appropriate for parotid carcinoma patients with high grade disease and/or an advanced T classification. Because preoperative evaluation of the histological grade of parotid carcinoma has limited reliability, it is important to decide the indications and range of neck dissection from the results of frozen section biopsy.
对于患有腮腺癌的患者，颈部清扫术的适应证和范围尚无共识，对于 cN0 疾病的选择性颈部清扫术尤其存在争议。
本研究回顾性分析了 1999 年 9 月至 2018 年 8 月在我科治疗的 185 例新诊断为腮腺癌的患者。
185 例患者中有 50 例发生淋巴结转移，T1、T2、T3 和 T4 疾病患者的淋巴结转移率分别为 7.7%、12.2%、36.0%和 55.8%。按组织学分级分类，低/中分级疾病患者的淋巴结转移率为 5.7%，而高分级疾病患者的淋巴结转移率为 55.0%。多因素分析显示，组织学分级和 T 分类是淋巴结转移的独立预测因素。73 例临床淋巴结阴性行颈部清扫术的患者中有 8 例发现隐匿性转移。颈部转移最常见的部位是 2 区，其次是腮腺周围淋巴结、3 区和 4 区。
选择性颈部清扫术可能最适合高分级疾病和/或 T 分类较晚的腮腺癌患者。由于术前评估腮腺癌的组织学分级可靠性有限，从冷冻切片活检结果来决定颈部清扫术的适应证和范围很重要。
