Violaris N S, O'Neil D, Helliwell T R, Caslin A W, Roland N J, Jones A S
Department of Otolaryngology/Head and Neck Surgery, University of Liverpool, UK.
Clin Otolaryngol Allied Sci. 1994 Oct;19(5):394-9. doi: 10.1111/j.1365-2273.1994.tb01255.x.
Some 497 of 3085 patients with squamous cell carcinoma of the head and neck treated between 1963 and 1990 had a later radical neck dissection at some time after initial treatment. The histological slides were all reviewed, firstly to confirm the presence of squamous cell carcinoma within the neck, and secondly to ascertain whether the metastasis was to soft tissue, to a lymph node or to both. The presence of extracapsular rupture in lymph node deposits was also assessed. Of the 497 patients, 138 had soft tissue deposits only, and 359 had nodal deposits only. Of the patients with nodal deposits 165 had extracapsular rupture and 194 did not. The 5-year survival of the 138 patients with soft tissue metastases was 27% compared with 33% for patients with extracapsular rupture and 50% for patients with no extracapsular rupture. Weighted logistic regression showed that soft tissue deposits were significantly more common in patients in poor general condition, plus poorly differentiated squamous cell carcinoma plus T4 tumours (P < 0.005), and in patients with poorly differentiated squamous cell carcinoma plus T4 tumours (P < 0.025). Cox's multivariate analysis with backward elimination showed that gender, histological differentiation, site of primary tumour and age of patient had no statistically significant effect on survival. The number of nodes (P < 0.0001), the presence of extracapsular rupture (P < 0.0001) and the presence of soft tissue free metastases (P < 0.001) were all highly significant. The N-status at recurrence also reached statistical significance (P < 0.0001).
1963年至1990年间接受治疗的3085例头颈部鳞状细胞癌患者中，约497例在初始治疗后的某个时间进行了晚期根治性颈清扫术。对所有组织学切片进行了复查，首先确认颈部是否存在鳞状细胞癌，其次确定转移是至软组织、淋巴结还是两者皆有。还评估了淋巴结转移灶中包膜外破裂的情况。在这497例患者中，138例仅有软组织转移灶，359例仅有淋巴结转移灶。在有淋巴结转移的患者中，165例有包膜外破裂，194例没有。138例有软组织转移的患者5年生存率为27%，有包膜外破裂的患者为33%，无包膜外破裂的患者为50%。加权逻辑回归显示，软组织转移在一般状况差、低分化鳞状细胞癌加T4肿瘤的患者中显著更常见（P<0.005），以及在低分化鳞状细胞癌加T4肿瘤的患者中（P<0.025）。采用向后剔除的Cox多因素分析显示，性别、组织学分化程度、原发肿瘤部位和患者年龄对生存率无统计学显著影响。淋巴结数量（P<0.0001）、包膜外破裂的存在（P<0.0001）和软组织无转移的存在（P<0.001）均具有高度显著性。复发时的N分期也具有统计学意义（P<0.0001）。
