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背景与目的:目前,对临床颈淋巴结阴性(cN0)的舌癌病例是否需行颈淋巴清扫术治疗仍存争议。本研究目的在于探讨舌体鳞癌的颈部淋巴结转移规律和分区性颈淋巴结清扫术应用于cN0舌癌病例的理论依据和应用原则。方法:回顾性分析1991年至1997年214例手术治疗的舌体鳞癌患者的临床资料;分析cN0pN+(病理检查淋巴结阳性)病例和cN+pN+病例的颈部转移淋巴结分布规律;比较不同分组的远期疗效;Cox回归分析法筛选影响舌体鳞癌患者预后的因素。结果:pN+病例69例,颈淋巴结转移率32.2%,其中同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占22.3%、33.5%、22.3%、4.6%、1.0%;对侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占6.6%、3.6%、3.0%、2.0%、0.5%。pN+组和pN0组5年生存率各为47%、83%(P<0.001);Cox回归分析显示影响舌体鳞癌患者预后的独立因素为T分期、N分期。结论:舌体鳞癌淋巴结转移最常见于同侧颈部Ⅰ、Ⅱ、Ⅲ区;分区性颈淋巴结清扫术对cN0病例既可起治疗的作用,又可用于评价颈部淋巴结转移状况以决定是否行全颈淋巴结清扫术。
BACKGROUND & OBJECTIVE: Currently, there is controversy over whether cervical lymph node dissection is needed for cervical cancer patients with clinically negative cervical lymph nodes (cN0). The purpose of this study is to investigate the rule of cervical lymph node metastasis of tongue squamous cell carcinoma and the application of zonal lymph node dissection in cN0 tongue cancer cases. Methods: The clinical data of 214 patients with squamous cell carcinoma of the tongue treated surgically from 1991 to 1997 were retrospectively analyzed. The distribution of cervical lymph node metastases in cN0pN + (pathologically examined lymph node positive) and cN + pN + cases was analyzed. Long-term efficacy; Cox regression analysis screening prognosis factors in patients with tongue squamous cell carcinoma. Results: There were 69 cases of pN + cases and 32.2% of cervical lymph node metastasis. The ipsilateral ¢ ò, ¢ ò, ¢ ó, ¢ ô and ¢ òare the highest in 22.3%, 33.5%, 22.3%, 4.6% and 1.0% Ⅲ, Ⅳ, Ⅴ each accounted for 6.6%, 3.6%, 3.0%, 2.0%, 0.5%. The 5-year survival rates of pN + and pN0 groups were 47% and 83%, respectively (P <0.001). Cox regression analysis showed that the independent factors affecting the prognosis of tongue squamous cell carcinoma were T stage and N stage. CONCLUSIONS: Lymph node metastasis of tongue squamous cell carcinoma is most common in the ipsilateral cervical regions Ⅰ, Ⅱ and Ⅲ. The regional cervical lymphadenectomy can not only play a role in the treatment of cN0, but also can be used to evaluate the status of cervical lymph node metastasis to decide whether Line neck lymph node dissection.