口腔癌中的隐匿性淋巴结转移
Occult Nodal Metastasis in Oral Cavity Cancers.
作者信息
Arain Asif Ali, Rajput Muhammad Shaheryar Ahmed, Ansari Shakil Akhtar, Mahmood Zafar, Ahmad Ahmad Nawaz, Dogar Muhammad Razzaq, Suahil Anwar
机构信息
Otolaryngology, The Indus Hospital, Karachi, PAK.
Otolaryngology, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
出版信息
Cureus. 2020 Nov 23;12(11):e11640. doi: 10.7759/cureus.11640.
INTRODUCTION
In squamous cell carcinoma (SCC) of the oral cavity, there is always a risk of occult metastasis to neck nodes in the clinically and radiologically negative neck (N0). Therefore, elective neck dissection (END) has ever been under discussion since the beginning of their routine use for the management of neck for oral carcinomas. The purpose of the current study is to identify the percentage of occult nodal metastasis to neck levels I-V in the cases of oral carcinoma who were treated for the N0 with END.
METHODS
Patients who were treated between June 2005 and May 2010 with END from neck levels I to V for the management of N0 with oral SCC had been identified from the database of Aga Khan University Hospital. Those who met the inclusion and exclusion criteria were included in the study. Data were analyzed using SPSS 16 software. Using descriptive statistics, the mean was computed for the quantitative variable (age). Frequencies and percentages were calculated for gender, site, tumor grade, and lymph node involvement for each neck level.
RESULTS
A total of 50 patients were included in the study. There were 38 males and 12 females. The mean age was 47 (range 25-72). The most common site of the tumor was buccal mucosa in 50% of the cases followed by tongue 20%, then floor of mouth 14%, dentoalveolar ridge 8%, retromolar area 4%, lip 2%, and hard palate 2%. Histopathological grading of tumors showed well-differentiated 28%, moderately differentiated 33%, and poorly differentiated 6%. Twenty-seven out of 50 patients were found positive for nodal metastasis on final postoperative histopathology. Neck node metastasis at level I was found in 22 patients, at level II in 16 patients, at level III in seven patients, and at level IV in two patients. The level V was found free of metastasis in all of the cases.
CONCLUSION
The rate of occult metastatic disease to the neck nodes was similar to that found in the literature. Both early and advanced local disease is associated with a risk of occult metastasis. END for neck levels I-V is, therefore, recommended for the management of the N0 in all cases of oral SCCs. Spread to levels IV and V is rare and these levels should not be a part of routine END.
引言
在口腔鳞状细胞癌（SCC）中，临床及影像学检查显示颈部阴性（N0）的患者始终存在颈部淋巴结隐匿转移的风险。因此，自选择性颈部清扫术（END）开始常规用于口腔癌颈部治疗以来，其一直备受讨论。本研究的目的是确定接受END治疗的N0期口腔癌患者中颈部I - V区隐匿性淋巴结转移的百分比。
方法
从阿迦汗大学医院数据库中识别出2005年6月至2010年5月期间接受颈部I至V区END治疗以处理N0期口腔SCC的患者。符合纳入和排除标准的患者被纳入研究。使用SPSS 16软件进行数据分析。采用描述性统计方法计算定量变量（年龄）的均值。计算每个颈部水平的性别、部位、肿瘤分级和淋巴结受累情况的频率及百分比。
结果
本研究共纳入50例患者。其中男性38例，女性12例。平均年龄为47岁（范围25 - 72岁）。肿瘤最常见的部位是颊黏膜，占50%的病例，其次是舌部，占20%，然后是口底，占14%，牙槽嵴，占8%，磨牙后区，占4%，唇部，占2%，硬腭，占2%。肿瘤的组织病理学分级显示高分化占28%，中分化占33%，低分化占6%。50例患者中有27例在术后最终病理检查中发现淋巴结转移阳性。I区颈部淋巴结转移见于22例患者，II区16例，III区7例，IV区2例。所有病例中V区均未发现转移。
结论
颈部淋巴结隐匿性转移疾病的发生率与文献报道相似。早期和晚期局部疾病均与隐匿性转移风险相关。因此，对于所有口腔SCC病例的N0期管理，建议行颈部I - V区END。转移至IV区和V区很少见，这两个区域不应作为常规END的一部分。
Zotero 插件