Brasilino de Carvalho M
Head and Neck Service, Heliópolis Hospital, São Paulo, Brazil.
Head Neck. 1998 Jan;20(1):16-21. doi: 10.1002/(sici)1097-0347(199801)20:1<16::aid-hed3>3.0.co;2-6.
The extracapsular spread of disease in modal metastasis of head and neck tumors is an important prognostic factor. However, the implications of the degree of capsular involvement are rarely mentioned. This is a prospective study which intends to investigate the role of transcapsular spread in metastatic lymph nodes on the outcome of patients with laryngeal or hypopharyngeal carcinoma.
This is a prospective study of 170 consecutive cases of previously untreated patients with squamous cell carcinoma of the larynx or the hypopharynx treated from January 1981 through January 1988 at the Head and Neck Service of the Heliópolis Hospital Complex, São Paulo, Brazil. In an attempt to understand better the influence of the extension of capsular lymph node involvement on recurrence and actuarial survival rates, the Kaplan-Meier method and Mantel-Cox test were used.
The nodal cervical relapse was associated only to a macroscopic transcapsular spread (confidence interval, 1.7-7.0). When the carcinoma was confined to the lymph node or only a microscopic transcapsular spread was present, no statistically significant differences were found in recurrence or in death rates. The 5-year global and disease-free actuarial survival rates were, respectively, 52.0% and 56.8% for cases without metastasis and 5.8% and 10.2% when macroscopic transcapsular spread was present (p < .0001). The capsular rupture was the most important independent prognostic factor associated with the N categories of the TNM clinical classification and with metastatic lymph node diameter.
The risks of recurrence and death are higher when there is macroscopic extracapsular extension. When the tumor is confined to the lymph node or shows a microscopic invasion beyond the capsule, there are no statistically significant differences in risk rates. The risk of capsular rupture is related to the N category of the classification TNM and the diameter of the metastatic lymph node, from 3 cm and larger.
头颈部肿瘤典型转移中疾病的囊外扩散是一个重要的预后因素。然而，包膜受累程度的影响很少被提及。这是一项前瞻性研究，旨在调查转移性淋巴结的穿包膜扩散对喉癌或下咽癌患者预后的作用。
这是一项对1981年1月至1988年1月在巴西圣保罗赫利奥波利斯医院综合院区头颈科接受治疗的170例未经治疗的喉或下咽鳞状细胞癌患者进行的前瞻性研究。为了更好地理解包膜淋巴结受累范围对复发率和精算生存率的影响，采用了Kaplan-Meier法和Mantel-Cox检验。
颈部淋巴结复发仅与肉眼可见的穿包膜扩散有关（置信区间，1.7 - 7.0）。当癌局限于淋巴结或仅存在显微镜下的穿包膜扩散时，在复发率或死亡率方面未发现统计学上的显著差异。无转移病例的5年总精算生存率和无病精算生存率分别为52.0%和56.8%，出现肉眼可见的穿包膜扩散时分别为5.8%和10.2%（p <.0001）。包膜破裂是与TNM临床分类的N类别和转移性淋巴结直径相关的最重要的独立预后因素。
当存在肉眼可见的囊外扩展时，复发和死亡风险更高。当肿瘤局限于淋巴结或显示显微镜下超出包膜的侵犯时，风险率无统计学上的显著差异。包膜破裂的风险与TNM分类的N类别以及直径3厘米及以上的转移性淋巴结有关。
