原发舌鳞状细胞癌患者颈部淋巴结Level Ⅳ转移风险因素的分析

摘要

目的 探讨舌鳞状细胞癌患侧颈部淋巴结Level Ⅳ转移的风险因素.方法 收集北京大学口腔医学院·口腔医院口腔颌面外科2000年1月至2011年12月舌鳞状细胞癌同期行颈淋巴结清扫术及原发灶手术治疗的患者248例(255侧),分别应用卡方检验及Logistic回归分析Level Ⅳ转移的影响因素,分析变量包括年龄、性别、生长方式、T分期、病理分级、Level Ⅲ转移、Level Ⅰ～Ⅲ的转移阳性淋巴结分区个数、Level Ⅰ～Ⅲ的转移淋巴结个数.结果 颈淋巴结转移患者147例(152侧),LevelⅣ转移21侧(21/255,8.2％),LevelⅣ跳跃性转移2侧(2/255,0.8％).卡方检验结果表明,年龄(P=0.020)、Level Ⅲ发生转移(P=0.000)、Level Ⅰ～Ⅲ的转移阳性淋巴结分区个数(≥2)(P=0.006)、Level Ⅰ～Ⅲ的转移淋巴结个数(≥3)(P=0.000)是独立的风险因素;Logistic回归分析显示,只有LevelⅢ发生转移(P=0.003)为Level Ⅳ转移的风险因素.结论 Level Ⅲ发生转移的舌癌患者的LevelⅣ转移风险增加.%Objective To investigate the risk factor for metastasis in Level Ⅳ of ipsilateral neck in tongue cancer patients.Methods A total of 248 tongue caner paitents(255 necks) that underwent radical neck dissection was enrolled in the study.Chi-square test and Logistic regression analysis were used to determine the factors associated with metastasis in Level Ⅳ.The variable included age,sex,growth type,T stage,histopathological grade,Level Ⅲ involvement,number of positive lymph nodes in Levels Ⅰ-Ⅲ.Results Out of 147 cases(152 necks)with positive lymph node,21 necks(8.2％,21/255) had Level Ⅲ involvement,and 2 necks(0.8％,2/255) developed skip metastasis.Chi-square test showed that age(P=0.020),Level Ⅲ involvement(P=0.000),number of positive Level(≥2 Levels) in Levels Ⅰ-Ⅲ (P=0.006),and number of positive lymph node(≥3 nodes)in Levels Ⅰ-Ⅲ (P=0.000)were identified as independent risk factor.Logistic regression analysis revealed that only Level Ⅲ involvement(P=0.003) was the risk factor for metastasis in Level Ⅳ.Conclusions In tongue cancer patients,Level Ⅲ[involvement was a high risk factor for metastasis in Level Ⅳ.