局部晚期喉癌颈部淋巴结转移规律及相关因素分析

doi:10.3760/cma.j.issn.1004-4221.2020.01.002

Abstract
Figure/Table
References(24)
Related Citation (6)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

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.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Xu Yi
	Zhang Ye
	Liu Shaoyan
	Wang Xiaolei
	Huang Xiaodong
	Qu Yuan
	Wang Kai
	Wu Runye
	Chen Xuesong
	Liu Qingfeng
	Sun Shiran
	Luo Xi
	Luo Jingwei
	Gao Li
	Xu Guozhen
	Yi Junlin

Key words： Locally advanced laryngeal cancer Squamous cell carcinoma Lymph node metastasis Risk factor

Received: 06 May 2019

Corresponding Authors: Yi Junlin,Email:yinlinl969@163.com

Cite this article:

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.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2020.01.002 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2020/V29/I1/6

[1]Chen W,Zheng R,Baade PD,et al. Cancer statistics in China,2015[J]. CA Cancer J Clin,2016,66(2):115-132. DOI:10.3322/caac.21338.
[2]Wolf GT,Fisher SG,Hong WK,et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer[J]. N Engl J Med,1991,324(24):1685-1690. DOI:10.1056/NEJM199106133242402.
[3]Forastiere AA,Goepfert H,Maor M,et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer[J]. N Engl J Med,2003,349(22):2091-2098. DOI:10.1056/NEJMoa031317.
[4]Tomik J,Skadzień J,Modrzejewski M. Evaluation of cervical lymph node metastasis of 1400 patients with cancer of the larynx[J]. Auris Nasus Larynx,2001,28(3):233-240. DOI:10.1016/s0385-8146(00)00116-4.
[5]Biau J,Lapeyre M,Troussier I,et al. Selection of lymph node target volumes for definitive head and neck radiation therapy:a 2019 Update[J]. Radiother Oncol,2019,134(1):1-9. DOI:10.1016/j.radonc.2019.01.018.
[6]Djordjevic V, Bukurov B, Arsovic N, et al. Prospective case-control study of efficacy of bilateral selective neck dissection in primary surgical treatment of supraglottic laryngeal cancers with clinically negative cervical findings (N0)[J]. Clinical Otolaryngology,2016, 41. DOI:10.1111/coa.12570.
[7]Cunsolo EM. Anatomy and physiology of the operated larynx[J]. Acta Otorhinolaryngol Italica,2010,30(5):238-243. DOI:10.1016/j.purol.2012.11.007.
[8]Gallo O,Fini-Storchi I,Napolitano L et al. Treatment of the contralateral negative neck in supraglottic cancer patients with unilateral node metastases (N1-3)[J]. Head Neck,2000,22(4):386-392. DOI:10.1002/1097-0347(200007)22:43.0. CO;2-5.
[9]Böttcher A,Olze H,Thieme N,et al,A novel classification scheme for advanced laryngeal cancer midline involvement:implications for the contralateral neck[J]. J Cancer Res Clin Oncol,2017,143(8):1605-1612. DOI:10.1007/s00432-017-2419-1.
[10]Zinis LORD,Piero-Nicolai MD,Davide-Tomenzoli MD,et al. The distribution of lymph node metastases in supraglottic squamous cell carcinoma:Therapeutic implications[J]. Head Neck,2002,24(10):913-920. DOI:10.1002/hed.10152.
[11]Mutlu V,Ucuncu H,Altas E,et al. The relationship between the localization,size,stage and histopathology of the primary laryngeal tumor with neck metastasis[J]. Eurasian J Med,2014,46(1):1-7. DOI:10.5152/eajm.2014.01.
[12]Ferlito A,Silver CE,Rinaldo A,et al. Selective neck dissection (ⅡA,Ⅲ):a rational replacement for complete functional neck dissection in patients with N0 supraglottic and glottic squamous carcinoma[J]. Laryngoscope,2008,118(4):676-679. DOI:10.1097/MLG.0b013e31815f6f25.
[13]Amar A,Chedid HM,Franzi SA,et al. Neck dissection in squamous cell carcinoma of the larynx:indication of elective contralateral neck dissection[J]. Braz J Otorhinolary,2012,78(1):7-10. DOI:10.1590/S1808-86942012000200002.
[14]Yilmaz T,HoalAS,Gedikoglu G,et al.Prognostic significance of histopathological parameters in cancer of the larynx[J]. Eur Arch Oto-Rhino-Laryngol,1999,256(3):139-144. DOI:10.1007/s004050050127.
[15]Marks JE,Devineni VR,Harvey J,et al. The risk of contralateral lymphatic metastases for cancers of the larynx and pharynx[J]. Am J Otolaryngol,1992,13(1):34-39. DOI:10.1016/0196-0709(92)90095-b.
[16]Gregor RT,Oei SS,Hilgers FJ,et al. Management of cervical metastases in supraglottic cancer[J]. Ann Otol Rhinol Laryngol,1996,105(11):845-850. DOI:10.1177/000348949610501101.
[17]Lim YC,Choi EC,Lee JS,et al. Is dissection of level Ⅳ absolutely necessary in elective lateral neck dissection for clinically N0 laryngeal carcinoma?[J]. Oral Oncol,2006,42(1):101-106. DOI:10.1016/j.oraloncology.2005.06.019.
[18]Khafif A,Fliss DM,Gil Z,et al. Routine inclusion of level Ⅳ in neck dissection for squamous cell carcinoma of the larynx:is it justified?[J]. Head Neck,2010,26(4):309-312. DOI:10.1002/hed.10390.
[19]Grégoire V,Coche E,Cosnard G,et al. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience[J]. Radiother Oncol,2000,56(2):135-150. DOI:10.1016/S0167-8140(00)00202-4.
[20]Garas J,Sr MG. Squamous cell carcinoma of the subglottis[J]. Am J Otolaryngol,2006,27(1):1-4. DOI:10.1016/j.amjoto.2005.05.004.
[21]Buckley JG,MacLennan K. Cervical node metastases in laryngeal and hypopharyngeal cancer:a prospective analysis of prevalence and distribution[J]. Head Neck,2000,22(2):380-385. DOI:10.1002/1097-0347(200007)22:4<380::AID-HED11>3.0. CO;2-E.
[22]Dahm JD,Sessions DG,Paniello RC,et al. Primary subglottic cancer[J]. Laryngoscope,1998,108(5):741-746. DOI:10.1097/00005537-199805000-00022
[23]Li B,Bobinski M,Gandour-Edwards R,et al. Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation[J]. Br J Radiol,2011,84(997):64-69. DOI:10.1259/bjr/66700901.
[24]Kuno H,Sakamaki K,Fujii S,et al. Comparison of MR imaging and dual-energy CT for the evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma[J]. Am J Neuroradiol,2018,39(3):524-531. DOI:10.3174/ajnr. A5530.