Netterville J L, Sinard R J, Bryant G L, Burkey B B
Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA.
Head Neck. 1998 Jul;20(4):328-33. doi: 10.1002/(sici)1097-0347(199807)20:4<328::aid-hed8>3.0.co;2-0.
Metastases from mucosal and cutaneous carcinomas can present in a delayed fashion, and this late presentation may confer a different prognosis after conventional treatment.
We present a series of patients in which there was a significant time delay between the treatment of a squamous carcinoma of the skin or mucosa of the midface and the detection of regional metastases in 12 of the 13 cases. Primary tumors were located on the lower lip and commissure (n = 3), nasal tip (n = 2), nasal ala (n = 1), columella (n = 1), nasofacial crease (n = 2), maxillary alveolus (n = 3), and mandibular alveolus (n = 1). Metastatic spread manifested by palpable perifacial or submandibular lymph nodes was not evident until greater than 11 months after the treatment of the primary site in 12 of 13 patients (range, 3-45 months). Nine of the patients were clinically staged as N1, whereas there was one each in the N2a, N2b, N2c, and N3 categories. Eleven of the 13 patients were initially seen with palpable disease involving the perifacial nodes within or around the submandibular gland. All patients were treated with neck dissection except one, who refused surgical treatment and underwent a second course of radiotherapy to the cervical region. The nine patients initially seen with clinical stage N1 disease underwent neck dissection with preservation of the sternocleidomastoid, internal jugular vein, and accessory nerve.
Of 10 patients with perifacial node metastases who underwent neck dissection, 8 required sacrifice of the marginal mandibular nerve and overlying platysma to gain adequate margin. Extracapsular spread was present in 11 patients, (8 of 9 who were clinically N1). Postoperative radiotherapy was recommended to all patients with extracapsular spread, although only 7 of the 11 received radiotherapy. There were no regional recurrences after a minimum follow-up of 1 year (range, 12-65 months; mean, 31.4 months). Histologic grade appeared to have no influence on prognosis.
This cohort demonstrates the ability of midfacial squamous cell carcinoma to manifest regional metastatic disease over a delayed time. This delayed presentation appears to confer a more favorable response to treatment. For midfacial cancers, the perifacial nodes are at greatest risk for metastatic spread. For tumors in this region, primary treatment of the neck is probably not warranted, but careful extended follow-up for the potential of delayed cervical metastasis is prudent.
黏膜癌和皮肤癌的转移可能会延迟出现，而这种延迟出现可能会使常规治疗后的预后有所不同。
我们报告了一系列患者，其中13例中有12例在治疗面部中部皮肤或黏膜鳞状癌与发现区域转移之间存在显著的时间延迟。原发肿瘤位于下唇和口角（3例）、鼻尖（2例）、鼻翼（1例）、鼻小柱（1例）、鼻面部皱折（2例）、上颌牙槽（3例）和下颌牙槽（1例）。13例患者中有12例（范围为3 - 45个月），直到原发部位治疗后超过11个月，通过可触及的面部周围或下颌下淋巴结表现出的转移扩散才明显。9例患者临床分期为N1，而N2a、N2b、N2c和N3类别各有1例。13例患者中有11例最初就诊时可触及病变累及下颌下腺内或周围的面部周围淋巴结。除1例拒绝手术治疗并接受颈部区域第二轮放疗的患者外，所有患者均接受了颈部清扫术。最初临床分期为N1疾病的9例患者接受了保留胸锁乳突肌、颈内静脉和副神经的颈部清扫术。
10例接受颈部清扫术的面部周围淋巴结转移患者中，8例需要牺牲下颌缘支神经及覆盖的颈阔肌以获得足够的切缘。11例患者存在包膜外扩散（临床N1的9例中有8例）。建议所有有包膜外扩散的患者术后放疗，尽管11例中只有7例接受了放疗。在至少随访1年（范围为12 - 65个月；平均31.4个月）后无区域复发。组织学分级似乎对预后没有影响。
该队列证明了面部中部鳞状细胞癌有能力在延迟时间后表现出区域转移性疾病。这种延迟出现似乎对治疗有更有利的反应。对于面部中部癌症，面部周围淋巴结发生转移扩散的风险最大。对于该区域的肿瘤，颈部的初始治疗可能没有必要，但谨慎地进行长期随访以监测潜在的延迟性颈部转移是明智的。
