[颈淋巴结转移密度对下咽癌预后的影响]
[The effect of cervical lymph node metastasis density on prognosis of hypopharyngeal carcinoma].
作者信息
Liu Z C, Lyu Z H, Ma J K, Feng S H, Liu X L, Wei Y M, Xu Wei
机构信息
Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Shandong University, Jinan 250023, China.
Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250023, China.
出版信息
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Aug 7;57(8):957-962. doi: 10.3760/cma.j.cn115330-20211126-00762.
To investigate the relationship between the cervical lymph node density (LND) and the prognosis of hypopharyngeal carcinoma. The clinical and pathological data of 241 patients with hypopharyngeal carcinoma who underwent surgery in Shandong Provincial ENT Hospital from January 2014 to December 2017 were retrospectively analyzed, including 229 males and 12 females, aged 37-81 years. The LND was calculated, i.e. the ratio of the number of lymph nodes with metastasis to the total number of lymph nodes removed. The patients were divided into low LND group and high LND group based on the cutoff value of LND determined by receiver operating characteristic curve (ROC curve). The univariate and multivariate analyses of the disease-free survival (DFS) and the overall survival (OS) were performed in two groups. With the cutoff value of 0.068, 165 patients were in the low LND group (<0.068) and 76 patients in the high LND group (≥0.068). T stage, N stage, maximum lymph node diameter, extracellular invasion of lymph node, and postpharyngeal lymph node metastasis were associated with LND (statistical values were -3.15, -6.82, 23.37, 20.44, and 30.18, respectively, all values were<0.05). The univariate analysis showed that age, T stage, N stage, maximum diameter of cervical lymph nodes, extracapsular invasion, retropharyngeal lymph node metastasis and LND were the main factors affecting the patients' DFS (χ=9.31, 7.30, 20.09, 15.30, 9.04, 19.44, 50.27, all values<0.05) and OS (χ were 5.02, 12.94, 18.28, 15.91, 7.95, 16.88, 49.45, all values<0.05). Multivariate analysis showed that patients with age≤60 years old and LND≥0.068 had reduced DFS [ values were 0.61 (95% 0.43-0.88) and 2.23 (95% 1.44-3.45), both values<0.05]; patients with advanced T stage and LND≥0.068 had reduced OS [ values were 1.73 (95% 1.02-2.93) and 2.39 (95% 1.51-3.80), both values<0.05]. LND is a prognostic factor for patients with hypopharyngeal carcinoma after surgery, with worse prognosis in patients with LND≥0.068.
探讨下咽癌颈部淋巴结密度（LND）与预后的关系。回顾性分析2014年1月至2017年12月在山东省耳鼻喉医院接受手术的241例下咽癌患者的临床及病理资料，其中男性229例，女性12例，年龄37 - 81岁。计算LND，即转移淋巴结数量与切除淋巴结总数的比值。根据受试者工作特征曲线（ROC曲线）确定的LND临界值，将患者分为低LND组和高LND组。对两组患者的无病生存期（DFS）和总生存期（OS）进行单因素和多因素分析。以临界值0.068划分，低LND组（<0.068）165例，高LND组（≥0.068）76例。T分期、N分期、最大淋巴结直径、淋巴结包膜外侵犯及咽后淋巴结转移与LND相关（统计值分别为 - 3.15、 - 6.82、23.37、20.44和30.18，均P<0.05）。单因素分析显示，年龄、T分期、N分期、颈部淋巴结最大直径、包膜外侵犯、咽后淋巴结转移及LND是影响患者DFS（χ² = 9.31、7.30、20.09、15.30、9.04、19.44、50.27，均P<0.05）和OS（χ²分别为5.02、12.94、18.28、15.91、7.95、16.88、49.45，均P<0.05）的主要因素。多因素分析显示，年龄≤60岁且LND≥0.068的患者DFS降低[比值分别为0.61（95% 0.43 - 0.88）和2.23（95% 1.44 - 3.45），均P<0.05]；T分期晚期且LND≥0.068的患者OS降低[比值分别为1.73（95% 1.02 - 2.93）和2.39（95% 1.51 - 3.80），均P<0.05]。LND是下咽癌患者术后的预后因素，LND≥0.068的患者预后较差。
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