颈部淋巴结处理方式对cNo声门上型喉癌患者预后的影响

发布时间：2018-10-12 07:59

【摘要】：目的总结颈部淋巴结的处理方式对cN0型声门上型喉癌预后的影响,探讨cN0型声门上型喉癌行选择性颈部Ⅱ、Ⅲ和(或)Ⅳ区淋巴结清扫的意义。方法回顾性分析2003年1月至2007年5月于郑州大学第一附属医院确诊为cN0型声门上型喉鳞状细胞癌且有完整病历资料的患者共83例,原发灶均经手术切除,随访5年以上或至患者死亡。分析择区性颈部淋巴结清扫术与其他方法(放射治疗、综合治疗、随诊观察)处理颈部淋巴结后,患者生存率有无统计学意义。结果 1.cN0型声门上型喉癌颈部淋巴结转移率为30.77%,且随着T分期的增加,颈淋巴结的转移率也逐渐增高。低分期(T1、T2)者颈淋巴结转移率明显低于高分期(T3、T4)者(P0.05)。 2.采取术中、术后干预措施(颈清扫、放疗以及综合治疗)患者的颈淋巴结复发率分别为20.96%、25.00%、20.00%；无术中、术后干预措施(临床观察)患者颈淋巴结复发率为46.43%,采取干预措施患者的颈部淋巴结复发率明显低于未采取干预措施患者(P0.05)。 3.清扫组与放疗组、综合组5年生存率分别为79.30%、75.00%、80.00%,差异均无显著性(P0.05),观察组5年生存率为57.10%,与清扫组差异有显著性(P0.05)。结论 1.cNo型声门上型喉癌患者有1/3左右有颈部淋巴结转移,且随着T分期的增加,颈淋巴结的转移率也逐渐增高。 2.对cNo声门上型喉癌患者颈部淋巴结行选择性颈清扫可明显降低患者颈部复发率,提高5年生存率。 3.对cNo声门上型喉癌患者,切除原发病灶同时行选择性颈清扫术的疗效与术后行颈部放射治疗与综合治疗的疗效相当,均优于切除原发病灶后临床观察患者。
[Abstract]:Objective to summarize the effect of cervical lymph node management on the prognosis of cN0 type supraglottic laryngeal carcinoma and to explore the significance of selective neck dissection in cN0 type supraglottic laryngeal carcinoma. Methods from January 2003 to May 2007, 83 patients with cN0 type supraglottic laryngeal squamous cell carcinoma diagnosed in the first affiliated Hospital of Zhengzhou University were retrospectively analyzed. Follow-up for more than 5 years or until the patient died. The survival rate of patients treated with selective cervical lymph node dissection and other methods (radiotherapy, combined therapy, follow-up observation) was analyzed. Results the cervical lymph node metastasis rate of 1.cN0 type supraglottic laryngeal carcinoma was 30.777.The metastasis rate of cervical lymph node increased with the increase of T stage. The rate of cervical lymph node metastasis in patients with low staging (T _ 1 / T _ 2) was significantly lower than that in patients with high grade (T _ 3 / T _ 4) (P0.05). The recurrence rate of cervical lymph nodes in patients with intraoperative and postoperative intervention (neck dissection, radiotherapy and combined therapy) was 20.96%, 25.00% and 20.00%, respectively. The recurrence rate of cervical lymph nodes was 46.43 in patients with intervention (clinical observation). The recurrence rate of cervical lymph nodes in patients with intervention was significantly lower than that in patients without intervention (P0.05). The 5-year survival rate in the sweeping group and radiotherapy group was 79.30% and 75.00%, respectively, with no significant difference (P0.05). The 5-year survival rate in the observation group was 57.10%, which was significantly higher than that in the sweeping group (P0.05). Conclusion 1 / 3 of the patients with 1.cNo type supraglottic laryngeal carcinoma have cervical lymph node metastasis, and with the increase of T stage, the cervical lymph node metastasis rate increases gradually. 2. Selective neck dissection in patients with cNo supraglottic laryngeal carcinoma could significantly reduce the cervical recurrence rate and increase the 5 year survival rate. In patients with cNo supraglottic laryngeal carcinoma, the curative effect of resection of primary lesions and selective neck dissection was similar to that of postoperative cervical radiotherapy and comprehensive treatment, and was superior to that of clinical observation after resection of primary lesions.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.65

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