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目的研究下咽癌颈淋巴转移的特点、规律及对预后的影响。方法收集1985—2000年住院治疗下咽癌患者108例,均经手术治疗,且术前未行放疗和化疗。根据1992年国际抗癌联合会(UICC)分期标准进行分期分级。手术后将下咽癌及颈淋巴结标本进行病理观察,确定肿瘤主体所在原发部位及发生转移的颈淋巴结分布区域。按照病理学将肿瘤的病理分化程度确定为高、中、低分化。通过颈淋巴结病理检查和随访观察确定颈淋巴转移情况,用Kaplan-Meier方法对3、5年生存率进行非参数分析。结果病例中T1、T2淋巴结转移率为45·8%,T3、T4淋巴结转移率为79·8%,总的淋巴结转移率为75·0%(81/108),(P<0·05)。梨状窝癌为100例,占全部病例的92·6%(100/108),梨状窝及下咽后壁癌的颈淋巴转移率分别为74·0%和87·5%(P>0·05)。病理高、中、低分化型3组,其颈淋巴转移率分别为72·2%、67·6%、85·7%(P>0·05)。患者3、5年累积生存率分为67·53%及29·87%。Ⅱ、Ⅲ区颈淋巴转移率为76·5%,Ⅴ、Ⅵ区颈淋巴转移率为8·6%。结论下咽癌颈淋巴转移率高。下咽癌颈淋巴转移是影响下咽癌的预后主要因素,随着颈淋巴转移程度的增加,患者3、5年生存率逐渐降低。
Objective To study the characteristics, regularity and prognosis of cervical lymphatic metastasis of hypopharyngeal carcinoma. Methods A total of 108 hospitalized patients with hypopharyngeal carcinoma were collected from 1985 to 2000. All of them were surgically treated without radiotherapy and chemotherapy. According to the 1992 International Union Against Cancer (UICC) staging criteria staging. After surgery, hypopharyngeal carcinoma and cervical lymph node specimens were observed pathologically to determine the location of the tumor where the main body and metastatic cervical lymph node distribution. According to the pathology of the pathological differentiation of the tumor was identified as high, moderate and poorly differentiated. Cervical lymph node metastasis was confirmed by pathological examination of cervical lymph nodes and follow-up observation. Non-parametric analysis of 3-year and 5-year survival rate was performed by Kaplan-Meier method. Results The rates of lymph node metastasis at T1 and T2 were 45.8%, the rates of lymph node metastasis at T3 and T4 were 79.8%, and the total lymph node metastasis rate was 75.0% (81/108) (P0.05) . The rate of cervical lymph node metastasis was 100.0% in all cases and 100.0% in all cases. The rates of cervical lymph node metastasis in cases of piriformis and posterior wall cancer were 74.0% and 87.5%, respectively (P> 0 · 05). The pathological lymph node metastasis rate was 72.2%, 67.6%, 85.7% (P> 0.05) in the high, moderate and poorly differentiated groups. The 3-year and 5-year cumulative survival rate of patients was 67.53% and 29.87% respectively. Cervical lymph node metastasis rate was 76.5% in group Ⅱ and Ⅲ, and cervical lymph node metastasis rate in group V and group Ⅵ was 8.6%. Conclusion The incidence of cervical lymph node metastasis is high. Hypopharyngeal carcinoma cervical lymph node metastasis is the main factor affecting the prognosis of hypopharyngeal cancer, with the increase of cervical lymph node metastasis, 3, 5-year survival rate of patients gradually decreased.