Zhang Xiwei, Zhang Ye, Yu Xiaoduo, Sun Ying, Miao Susheng, Liu Shaoyan, Li Zhengjiang, Yi Junlin, An Changming
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.
Departments 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.
Front Oncol. 2021 Sep 20;11:727991. doi: 10.3389/fonc.2021.727991. eCollection 2021.
Most hypopharyngeal cancers (HPCs) develop lymph node metastasis (LNM) at initial diagnosis. Understanding the pattern of LNM in HPC could help both surgeons and radiologists make decisions in the management of cervical lymph nodes.
A total of 244 newly diagnosed HPC patients between January 2010 and December 2018 were recruited from three specialized cancer hospitals in mainland China. All patients received pre-treatment magnetic resonance imaging (MRI), and definitive radiotherapy with or without concurrent chemotherapy. We reassessed the features of the primary tumor (tumor size, primary location, and extent of invasion) and the involvement of lymph nodes at each level. According to the incidence of LNM, these levels were sequenced and sorted into drainage stations. Univariate and multivariate analyses were used to determine the risk factors for bilateral and regional lymph node metastasis.
The cohort consisted of 195 piriform sinus cancers (PSC), 47 posterior wall cancers (PWC), and 2 post-cricoid cancers (PCC). A total of 176 patients (72.1%) presented with MRI-detectable LNMs. The overall LNM rates for level II-VI and retropharyngeal lymph nodes (RPLNs) were 59.0%, 52.9%, 14.3%, 1.6%, 2.9%, and 16.4%, respectively. Based on the prevalence of LNM at each level, we hypothesize that the lymphatic drainage of PSC was carried out in sequence along three stations: Level II and III (61.0% and 55.4%), Level IV and RPLN (15.9% and 11.3%), and Level V and VI (1.5% and 3.1%). For PWCs, lymphatic drainage is carried out at two stations: Level II, III, and RPLN (48.9%, 40.4%, and 34.0%) and Level IV-VI (6.4%, 0%, and 2.1%). According to univariate and multivariate analyses, posterior wall invasion was significantly correlated with bilateral LNM (P = 0.030, HR = 2.853 95%CI, 1.110-7.338) and RPLN metastasis (P = 0.017, HR = 2.880 95%CI, 1.209-6.862). However, pyriform sinus invasion was less likely to present with bilateral LNM (P = 0.027, HR = 0.311, 95%CI, 0.111-0.875) and RPLN metastasis (P = 0.028, HR = 0.346, 95%CI, 0.134-0.891).
The primary tumor site and extent of invasion are related to the pattern of lymph node metastasis. That is, the metastasis would drainage station by station along different directions.
大多数下咽癌（HPC）在初诊时就发生淋巴结转移（LNM）。了解HPC的LNM模式有助于外科医生和放射科医生在颈部淋巴结管理中做出决策。
2010年1月至2018年12月期间，从中国大陆的三家专业癌症医院招募了244例新诊断的HPC患者。所有患者均接受了治疗前磁共振成像（MRI）以及有或无同步化疗的根治性放疗。我们重新评估了原发肿瘤的特征（肿瘤大小、原发部位和侵犯范围）以及每个层面淋巴结的受累情况。根据LNM的发生率，对这些层面进行排序并分类到引流站。采用单因素和多因素分析来确定双侧和区域淋巴结转移的危险因素。
该队列包括195例梨状窦癌（PSC）、47例后壁癌（PWC）和2例环状软骨后癌（PCC）。共有176例患者（72.1%）出现MRI可检测到的LNM。II - VI区和咽后淋巴结（RPLN）的总体LNM率分别为59.0%、52.9%、14.3%、1.6%、2.9%和16.4%。基于每个层面LNM的发生率，我们假设PSC的淋巴引流按三个站依次进行：II区和III区（61.0%和55.4%）、IV区和RPLN（15.9%和11.3%）、V区和VI区（1.5%和3.1%）。对于PWC，淋巴引流在两个站进行：II区、III区和RPLN（48.9%、40.4%和34.0%）以及IV - VI区（6.4%、0%和2.1%）。根据单因素和多因素分析，后壁侵犯与双侧LNM（P = 0.030，HR = 2.853，95%CI，1.110 - 7.338）和RPLN转移（P = 0.017，HR = 2.880，95%CI，1.209 - 6.862）显著相关。然而，梨状窦侵犯出现双侧LNM（P = 0.027，HR = 0.311，95%CI，0.111 - 0.875）和RPLN转移（P = 0.028，HR = 0.346，95%CI，0.134 - 0.891）的可能性较小。
原发肿瘤部位和侵犯范围与淋巴结转移模式相关。也就是说，转移会沿不同方向逐站引流。
