Woolgar J A
University of Liverpool School of Dentistry, UK.
Int J Oral Maxillofac Surg. 1997 Feb;26(1):3-9. doi: 10.1016/s0901-5027(97)80837-5.
The histologic presence and detailed topography of cervical lymph node metastatic tumours was investigated in a series of neck dissections from 154 previously untreated patients with oral mucosal squamous cell carcinoma. Metastasis was evident in 73 patients (47%), including 13 (8%) with bilateral spread and 14 (9%) with only micrometastases. Multiple positive nodes were recovered from 58 (67%) of the 86 positive sides of neck dissection, and fusion of nodes was seen in 22 dissections (26%). Both direct extracapsular and embolic spread accounted for advanced disease. An orderly progressive ("overflow") involvement of anatomic levels was seen in 85% of positive dissections. "Skipping" of anatomic levels II and/or III was seen in 10% and "peppering" of nodes at multiple levels without any macroscopic focus in 5%. Hence, "fasttracks" may account for the distribution of metastatic carcinoma in 15% of positive necks. Adjuvant radiotherapy was dependent on the pathologic stage. The range of postoperative follow-up was 1-6 years. Death from recurrent regional disease occurred only in patients who had exhibited macroscopic or microscopic extracapsular spread. Survival was similar (75%) for patients with either macroscopic or microscopic metastases confined to lymph nodes or no evidence of metastasis. Hence, with surgery and adjuvant radiotherapy, metastases confined to lymph nodes do not appear to affect the short-term prognosis.
在对154例未经治疗的口腔黏膜鳞状细胞癌患者进行的一系列颈部清扫术中，研究了颈部淋巴结转移瘤的组织学表现及详细的部位分布。73例患者（47%）出现转移，其中13例（8%）为双侧转移，14例（9%）仅为微转移。在86个颈部清扫阳性侧中的58个（67%）发现多个阳性淋巴结，22例清扫标本（26%）可见淋巴结融合。直接的包膜外扩散和栓塞性扩散均导致疾病进展。85%的阳性清扫标本可见解剖层面呈有序的渐进性（“溢出”）累及。10%的标本可见解剖层面II和/或III的“跳跃”，5%的标本可见多个层面的淋巴结“散在分布”而无任何宏观病灶。因此，“快速转移途径”可能导致15%的阳性颈部出现转移性癌的分布。辅助放疗取决于病理分期。术后随访时间为1至6年。仅在出现宏观或微观包膜外扩散的患者中发生区域性疾病复发导致的死亡。局限于淋巴结的宏观或微观转移患者或无转移证据患者的生存率相似（75%）。因此，对于手术联合辅助放疗，局限于淋巴结的转移似乎不影响短期预后。
