择区性颈清扫术淋巴结检出数与下咽鳞状细胞癌患者预后的关系

摘要

Objective To evaluate the influence of the number of lymph nodes retrieved after selective neck dissection(SND)on the prognosis of hypopharyngeal squamous carcinoma.Methods A restropective review was performed on 96 patients with hypopharyngeal squamous carcinoma between January 1995 and December 2009,and SND was included in initial treatments in all cases.Results The mean number of lymph nodes retrieved in all patients with hypopharyngeal squamous carcinoma was 19.0 ± 11.3.Preoperative radiotherapy significantly decreased the number of retrieved lymph nodes and positive lymph nodes(t =-4.45,P ＜ 0.001 and U =568,P ＜ 0.001,respectively).The 3-year overall survival rates were 37.7％ in patients with the number of retrieved nodes of ≤15 and 71.3％ in those with the number of retrieved nodes of ＞ 15,with a significant difference(x2 =8.214,P ＜ 0.01).The 3-year disease-free survival rates were 34.8％ in patients with ≤ 15 nodes and 61.7％ in those with ＞ 15 nodes(x2 =7.345,P＜0.01).The 3-year neck-control rates were 97.4％ and 76.7％(＞ 15 nodes vs.≤15 nodes;x2 =5.539,P ＜ 0.05),respectively.After adjusting for the effect of T stage and N stage on multivariate analysis,the number of retrieved nodes of ＞ 15 in SND was an independent prognostic factor for overall survival(HR =0.48,P ＜ 0.05)and disease-free survival(HR =0.52,P ＜ 0.05).Conclusions The number of lymph nodes retrieved is a valuable prognostic factor in patients received SND for hypopharyngeal squamous carcinoma.These results suggest that at least 15 nodes should be dissected in this setiting.%目的 探讨颈清扫术后手术标本淋巴结检出数与下咽鳞状细胞癌患者预后的关系.方法 回顾性分析1995年1月至2009年12月在中国医学科学院肿瘤医院头颈外科接受择区性颈清扫术96例下咽鳞状细胞癌患者的临床资料.正态分布的计量资料采用t检验,非正态分布的计量资料采用Mann-Whitney U检验,计数资料采用x2检验.结果 全部患者一侧择区性颈清扫平均淋巴结检出数为(19.0±11.3)枚.术前放疗是影响淋巴结检出数(t=-4.450,P＜0.001)及阳性淋巴结检出数(U=568,P＜0.001)的重要因素.一侧择区性颈清扫术淋巴结检出数＞15枚及≤15枚的患者,3年总体生存率分别为71.3％和37.7％,两者差异有统计学意义(x2=8.214,P＜0.01)；3年无瘤生存率分别为61.7％和34.8％,两者差异有统计学意义(x2=7.345,P＜0.01)；3年颈部控制率分别为97.4％和76.7％,差异有统计学意义(x2=5.539,P＜0.05).多因素分析发现淋巴结检出数＞15枚是影响患者总生存率和无瘤生存率的独立危险因素(危险比分别为0.48和0.52,P值均＜0.05).结论 择区性颈清扫术检出淋巴结数可以用来预测下咽鳞状细胞癌患者的预后；一侧择区性颈清扫术最好检出15枚以上的淋巴结.