Patterns and risk factors of lymph node metastasis in locally advanced supraglottic squamous cell carcinoma
Xu Yi1, Zhang Ye1, Liu Shaoyan1, Wang Xiaolei2, Huang Xiaodong1, Qu Yuan1, Wang Kai1, Wu Runye1, Chen Xuesong1, Liu Qingfeng1, Sun Shiran1, Luo Xi1, Luo Jingwei1, Gao Li1, Xu Guozhen1, Yi Junlin1
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China 2Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021, China
Abstract：Objective To investigate the pattern of lymph node metastasis (LNM) in patients with locally advanced (T3,T4) laryngeal squamous cell carcinoma (LALSC) and provide reference for the delineation of clinical target volume. Methods Clinical data of 272 patients with LALSC treated in our hospital from 2000 to 2017 were retrospectively analyzed. All patients underwent bilateral neck dissection (at least level Ⅱ-Ⅳ). The LNM ratio of each node level was calculated. The risk factors of LNM were identified by univariate and multivariate logistic regression analyses. Results LNM was found in 156 of 272 patients (57.1%). According to the location of primary lesions, all patients were divided into group A (n=72;unilateral without midline involvement), group B (n=86;unilateral with midline involvement) and group C (n=114;giant or central). In group A, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and Ⅳ was 36.3%, 26.4% and 6.9%, whereas 13.9%, 8.3% and 1.4% at the contralateral level, respectively. In group B, the LNM ratio at ipsilateral level Ⅱ, Ⅲ and IV was 1.9%,29.1% and 11.6%, whereas 18.6%,14.0% and 1.2% at the contralateral level, respectively. In group C, the LNM ratio at the left neck level Ⅱ, Ⅲ and Ⅳ was 24.6%, 23.7% and 2.6%, whereas 21.9%, 26.3% and 6.1% at the right neck, respectively. Bilateral LNM ratio did not significantly differ between group A and group B/C (15.3%,25.0%,P=0.093). Ipsilateral level Ⅲ metastasis (OR=2.929,95%CI 1.041-8.245,P=0.042) and clinical N stage (OR=0.082,95%CI 0.018-0.373,P=0.001) were associated with contralateral LNM. Ipsilateral level Ⅱ(P=0.043) or Ⅲ(P=0.009) metastasis were risk factors of the ipsilateral level Ⅳ metastasis. Conclusion s Neck levels Ⅱ and Ⅲ are the high-risk LNM regions, whereaslevels Ⅳ and V are the low-risk areas. Ipsilateral level Ⅱ or Ⅲ metastases are the risk factors of ipsilateral level Ⅳ and contralateral cervical LNM. Contralateral neck LNM rarely occurs in cN0 stage patients.
Xu Yi,Zhang Ye,Liu Shaoyan et al. Patterns and risk factors of lymph node metastasis in locally advanced supraglottic squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(1): 6-10.
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2020, Vol. 29 
