华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (4): 422-427.doi: 10.7518/hxkq.2022.04.008

• 临床研究 • 上一篇    下一篇

原发性舌鳞状细胞癌颈淋巴结低位转移规律的临床研究

杨云博1(), 韩楠男2, 王钰璞2, 李华盛2, 严明2, 李思毅2, 阮敏2(), 张陈平2   

  1. 1.潍坊医学院口腔医学院,潍坊 261053
    2.上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011
  • 收稿日期:2022-02-08 修回日期:2022-04-28 出版日期:2022-07-25 发布日期:2022-07-27
  • 通讯作者: 阮敏 E-mail:565350445@qq.com;doctorruanmin@sjtu.edu.cn
  • 作者简介:杨云博,住院医师,硕士,E-mail:565350445@qq.com
  • 基金资助:
    国家自然科学基金(82072983);上海医苑新星人才计划杰出医师(沪[2021]99号)

Clinical study on the pattern of lower-level lymphatic metastasis in primary tongue squamous cell carcinoma

Yang Yunbo1(), Han Nannan2, Wang Yupu2, Li Huasheng2, Yan Ming2, Li Siyi2, Ruan Min2(), Zhang Chenping2   

  1. 1.School of Stomatology, Weifang Medical University, Weifang 261053, China
    2.Dept. of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • Received:2022-02-08 Revised:2022-04-28 Online:2022-07-25 Published:2022-07-27
  • Contact: Ruan Min E-mail:565350445@qq.com;doctorruanmin@sjtu.edu.cn
  • Supported by:
    The National Natural Science Foundation of China(82072983);Shanghai Medical Garden Rising Star Talent Program (Hu[2021]No. 99). Correspondence: Ruan Min, E-mail: doctorruanmin@sjtu.edu.cn

摘要:

目的 研究分析原发性舌鳞状细胞癌颈部淋巴结低位(Ⅳ区和Ⅴ区)转移的临床规律,为舌癌颈部淋巴结低位区域的清扫决策提供参考依据。方法 选取2010年1月—2015年12月上海交通大学医学院附属第九人民医院收治的原发性舌鳞状细胞癌同期或二期行全颈(Ⅰ~Ⅴ区)淋巴结清扫患者203例,收集其临床病理资料及随访信息,分析原发舌鳞状细胞癌颈部低位淋巴结转移的临床病理影响因素和预后。结果 在203例患者中,Ⅳ区和Ⅴ区转移率分别为14.78%和4.93%,男性较女性更易出现Ⅳ区转移(P=0.04),不吸烟较吸烟更易出现V区转移(P=0.046);Ⅲ区和Ⅳ区的淋巴结状态与Ⅴ区转移风险明显相关(P=0.001);Ⅲ区包膜外侵犯患者发生Ⅳ区(P=0.014)和V区(P=0.026)转移的风险明显增加;发生低位淋巴结(Ⅳ/Ⅴ)转移的患者5年生存率仅为14.70%,是原发性舌鳞状细胞癌患者的独立不良预后因素(P<0.000 1)。结论 原发性舌鳞状细胞癌绝大部分转移发生于Ⅰ~Ⅲ区,低位淋巴结转移比率较低,对于cN0患者和Ⅰ~Ⅱ区淋巴结转移但无包膜外侵犯的cN+患者,Ⅴ区淋巴结可以选择观察。

关键词: 舌鳞状细胞癌, 淋巴结转移, 颈淋巴结清扫, Ⅴ区, 包膜外侵犯

Abstract:

Objective To study and analyze the clinical patterns of lower-level lymph node (Ⅳ and Ⅴ) metastasis in primary tongue squamous cell carcinoma, and establish a reference for the decision-making of the lower-level neck dissection in tongue squamous cell carcinoma. Methods A total of 203 patients with primary tongue squamous cell carcinoma were recruited. These patients underwent simultaneous/secondary comprehensive neck (level Ⅰ-Ⅴ) dissection in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from January 2010 to December 2015. Their clinicopathological and follow-up data were obtained and analyzed to reveal the prognosis and risk factors of primary tongue squamous cell carcinoma with lower-level lymph node metastasis. Results Among the 203 patients, the metastasis rates of levels Ⅳ and Ⅴ are 14.78% and 4.93%, respectively. Level Ⅳ metastasis is more prevalent in males than females (P=0.04); non-smokers are more likely to have level Ⅴ metastasis than smokers (P=0.046). Lymph node status in levels Ⅲ and Ⅳ are significantly associated with the risk of metastasis in level Ⅴ (P=0.001). Patients with extracapsular invasion in level Ⅲ have a significantly increased risk of metastasis in levels Ⅳ (P=0.014) and Ⅴ (P=0.026). The 5-year survival rate of patients with lower lymph node (Ⅳ/Ⅴ) metastasis is only 14.70%, which is an independent poor prognostic factor for patients with primary tongue squamous cell carcinoma (P<0.000 1). Conclusion Most primary tongue squamous cell carcinoma metastases occur in levels Ⅰ-Ⅲ. However, the rate of lower-level lymph node metastasis is rather low. For the cN0 and cN+ patients with levels Ⅰ-Ⅱ lymph node metastases without extracapsular invasion, the strategy for level Ⅴ management may be observation rather than dissection.

Key words: tongue squamous cell carcinoma, lymph node metastasis, neck dissection, level Ⅴ, extracapsular invasion

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