Xu Yi, Zhang Ye, Xu Zhengang, Liu Shaoyan, Xu Guozhen, Gao Li, Luo Jingwei, Huang Xiaodong, Wang Kai, Qu Yuan, Zhang Shiping, Liu Qingfeng, Wu Runye, Chen Xuesong, Yi Junlin
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2020 Aug 27;10:1596. doi: 10.3389/fonc.2020.01596. eCollection 2020.
To investigate the prevalence and distribution of cervical lymph node metastasis (LNM) in locally advanced supraglottic squamous cell carcinoma (LASCC) and guide the delineation of clinical lymph node target volumes.
We reviewed patients defined as LASCC from January 2000 to December 2017 in our hospital. The primary tumor was operated on using partial or total laryngectomy, and all patients underwent bilateral neck dissection (levels II-IV at least). Univariate and multivariate logistic regressions were used to find risk factors associated with LNM.
A total of 206 patients were enrolled. In the whole group, the rate of ipsilateral metastasis (IM) was 60.9% (67 patients), whereas contralateral metastasis was 25.5% (28 patients). Only positive ipsilateral lymph nodes contributed to contralateral metastasis ( = 0.001). Seventy-six cases were diagnosed with clinical positive lymph nodes (cN). IM of primary lesions mainly located within the unilateral sites ( = 49 patients) was detected in levels II, III, and IV with lymph node metastasis ratios of 73.5% (36 patients), 63.3% (31 patients), and 20.4% (10 patients), respectively, and contralateral metastasis of 36.7% (18 patients), 16.3% (8 patients), and 6.1% (3 patients), respectively. Involvement of level II or III was associated with metastasis of level IV. No one developed contralateral level IV involvement without metastasis of contralateral levels II and III. A total of 130 cases had clinically negative neck lymph nodes (cN0). The prevalence of occult metastasis (OM) was 35.4%. Among 62 patients with unilateral lesions, the rates of OM to ipsilateral neck levels II, III, and IV were 21, 11.1, and 1.6%, respectively, whereas contralateral neck levels were 6.3, 4.8, and 0%, respectively. In terms of the risk factors, histopathological differentiation was related to OM ( = 0.003). Two of 25 people were with level VIb metastasis, and both of them were with subglottic involvement.
Neck levels II to IV are most frequently involved and should be included in clinical target volume (CTV) in cN patients. Contralateral IV may be omitted when contralateral levels II and III are negative. In cN0 patients, ipsilateral levels II and III are suggested to be included in the CTV, whereas whether contralateral levels II and III should be included needs further research.
探讨局部晚期声门上型鳞状细胞癌（LASCC）颈部淋巴结转移（LNM）的发生率及分布情况，以指导临床淋巴结靶区的勾画。
我们回顾性分析了2000年1月至2017年12月在我院确诊为LASCC的患者。对原发性肿瘤行部分或全喉切除术，所有患者均接受双侧颈部清扫术（至少清扫Ⅱ-Ⅳ区）。采用单因素和多因素logistic回归分析寻找与LNM相关的危险因素。
共纳入206例患者。在整个研究组中，同侧转移（IM）率为60.9%（67例），而对侧转移率为25.5%（28例）。仅同侧阳性淋巴结与对侧转移有关（P = 0.001）。76例患者被诊断为临床阳性淋巴结（cN）。原发性病变的IM主要位于单侧部位（n = 49例），在Ⅱ、Ⅲ和Ⅳ区的淋巴结转移率分别为73.5%（36例）、63.3%（31例）和20.4%（10例），对侧转移率分别为36.7%（18例）、16.3%（8例）和6.1%（3例）。Ⅱ区或Ⅲ区受累与Ⅳ区转移相关。对侧Ⅱ区和Ⅲ区无转移时，无人发生对侧Ⅳ区受累。共有130例患者颈部淋巴结临床阴性（cN0）。隐匿性转移（OM）的发生率为35.4%。在62例单侧病变患者中，同侧颈部Ⅱ、Ⅲ和Ⅳ区的OM发生率分别为21%、11.1%和1.6%，而对侧颈部的发生率分别为6.3%、4.8%和0%。在危险因素方面，组织病理学分化与OM相关（P = 0.003）。25例患者中有2例发生Ⅵb区转移，且均伴有声门下受累。
Ⅱ-Ⅳ区颈部淋巴结最常受累，cN患者的临床靶区（CTV）应包括这些区域。当对侧Ⅱ区和Ⅲ区阴性时，对侧Ⅳ区可省略。对于cN0患者，建议CTV包括同侧Ⅱ区和Ⅲ区，而对侧Ⅱ区和Ⅲ区是否应包括在内需要进一步研究。
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