摘要
目的 探讨术后辅助放疗控制头颈部鳞状细胞癌（简称头颈鳞癌）颈淋巴结转移的效果和影响颈部复发及远处转移的临床病理学因素.方法 回顾性分析208例接受术后颈部辅助放疗的病理性颈淋巴结转移（pN＋）的头颈鳞癌患者的临床病理学资料及随访结果.纳入研究的肿瘤原发灶相关临床病理学因素包括：性别、年龄、病理T分期,以及肿瘤部位、大小、病理分级、生长方式及手术切缘情况;纳入研究的颈淋巴结病理学因素包括：病理N分期、阳性淋巴结大小、数目、受侵分区数及包膜外侵犯（extracapsular spread,ECS）情况.应用x2检验及Logistic回归进行数据资料统计分析.结果 术后辅助放疗5年的治疗侧颈部控制率为72.6％ （151/208）,其中颈择区清扫术后颈部控制率为84.0％（63/75）,颈改良清扫术后为72.9％（78/107）,颈全清扫术后为38.5％ （10/26）.单因素分析显示,原发灶部位、pN分期、阳性淋巴结大小、阳性淋巴结受侵分区数、阳性淋巴结数目以及阳性淋巴结ECS与治疗侧颈部控制率明显相关;pN分期、阳性淋巴结受侵分区数与患者出现远处转移有关.多因素回归分析显示,阳性淋巴结ECS是影响pN＋头颈鳞癌患者治疗侧颈部控制率最重要因素;阳性淋巴结受侵分区数是影响远处转移最重要的淋巴结病理学因素.结论 淋巴结ECS是术后制定辅助治疗方案最重要的肿瘤病理学指标,应常规术后病理评价;对于颈转移伴有ECS的患者,术后辅助放疗在控制颈部复发中的作用有限,而阳性淋巴结受侵分区数（＞1）是影响远处转移最重要的淋巴结病理学因素;对这些病理因素应实施包括同步放化疗、靶向治疗在内的更加积极的治疗方案,以减少和控制颈部复发和远处转移.
Objective To investigate the clinicopathologic factors associated with neck control and distant metastasis in patients with neck metastases in head and neck squamous cell carcinoma （HNSCC）after postoperative radiation as adjuvant treatment.Methods Clinicopathologic data of 208 pathologic N ＋ （pN ＋） patients with HNSCC initially treated with neck dissection and postoperative radiation in Bethune International Peace Hospital of China from January 2004 to December 2009 were reviewed.The clinicopathologic factors,includeding age,sex,primary tumor site,pathologic T and N stage,tumor growth pattern,histological grade,tumor resection margin,size and number of positive lymph node,number of levels with positive lymph node,and extracapsular nodal spread （ECS）,were evaluated for their association with neck control and distant metastasis in patients with HNSCC after postoperative radiation.Univariate x2 test and multiple stepwise logistic regression model were used for the analysis.Results Overall 5-year neck control rate after postoperative radiotherapy was 72.6% （151/208）,with 84.0% （63/75） for SND,72.9% （78/107） for MRND,and 38.5% （10/26） for RND,respectively.Univariate analysis showed that neck control after postoperative radiation was related with following factors：primary tumor site,pathologic N stage,size of positive node,number of levels with positive node,number of positive node,and ECS.Pathologic N stage and number of levels with positive lymph node were associated with distant metastasis.Multivariate analysis indicated that ECS was the most significant risk factor for neck metastasis after surgery and postoperative radiotherapy and the number of levels with positive node was the most significant risk factor for distant metastasis.Conclusions ECS is the most important pathologic factor in planning postoperative adjuvant treatment for pN ＋ patients with HNSCC,therefore ECS should be evaluated routinely after neck dissection.The value of postoperative radiotherapy in controlling th
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2016年第7期485-490,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
头颈部肿瘤
癌
鳞状细胞
淋巴转移
放射疗法
复发
病理学
临床
Head and neck neoplasms
Carcinoma,squamous cell
Lymphatic metastasis
Radiotherapy
Recurrence
Pathology,clinical
