摘要
目的探讨舌体鳞癌N0患者颈部淋巴结治疗方法,以减少临床上的失误或过度治疗。方法对1985至2002年间165例舌体鳞癌N0患者进行回顾性研究。对部分T1、T2及T3期患者切除原发灶,进行颈部观察;其余T2期以上患者或无法随访的T1期者采取选择性颈淋巴清扫,全部病例术后随访3年以上。各组间的比较采用χ2检验。结果120例行选择性颈淋巴清扫术(END),33例术后病理证实淋巴结转移,45例单纯原发灶切除病例中9例出现颈淋巴转移。淋巴结隐匿性总转移率为25.5%,并随临床T分期的增高而增高。观察组总体颈部失控死亡率(20.0%)与END组(5.0%)相比,差异有显著性(P<0.05)。T1期观察组和END组的颈部失控死亡率分别为7.7%和4.0%,两组间差异无显著性(P>0.05);而将T2、T3期作为中期病变合并,观察组(70.0%)和END组(0)差异有显著性(P<0.001)。结论舌体鳞癌颈部隐匿性淋巴结转移率随临床T分期的增高而增高,对T2期以上N0舌体鳞癌患者应考虑行选择性颈清扫术,以提高其颈部控制率和生存率;对T1N0患者,如能够严密随访,可考虑单纯局部切除原发灶,以提高生存质量。
Objective To explore the treatment of patients with clinically negative neck lymph node （CN0） squamous cell carcinoma of tongue, in order to prevent clinical mistreatment and overtreatment. Methods 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of patients at stages T1 , T2 and T3 underwent resection of primary lesion followed by neck observation,and other patients at stages above T2 or non-followed up were treated with elective neck lymph node dissection（ END ）. All patients were followed up for more than 3 years or until death. Chi square test was employed to compare results between groups. Results Lymphatic metastasis was identified histologically after operation in 33 of 120 END patients, and neck lymph node metastasis was found in 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymph node metastasis was 25.5% ,which increased with elevating clinical T stage. The overall rate of death due to uncontrolled neck was 20.0% in observation group and 5.0% in END group, with significant difference between them （ P 〈： 0.05）. The rate of death due to uncontrolled neck was 7.7% and 4, 0% in T1 patients of the 2 groups respectively,with no significant difference between them （P 〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference（ P 〈 0.05 ） could be obtained between observation （70.0%） and END groups （0）. Conclusions The occult metastasis rate of squamous cell carcinoma of tongue increases with elevation of clinical stage, and elective neck node dissection can be considered for NO patients at stage over T2 to improve neck control and survival rate. Regional resection alone of primal3, lesion could be considered for T1 No patients to improve quality of life if closely followed up.
出处
《中国肿瘤临床与康复》
2005年第6期546-548,共3页
Chinese Journal of Clinical Oncology and Rehabilitation
基金
汕头市科技局重点科技计划项目
关键词
舌肿瘤
隐匿性转移
颈淋巴结清扫术
Tongue neoplasms
Lymph nodes
Occult lymphatic metastasis
Elective neck dissection
