Neck treatment strategy for pathologically node positive tongue squamous cell carcinoma
10.3760/cma.j.issn.1673-0860.2009.11.009
- VernacularTitle:淋巴转移阳性舌体鳞癌的颈部治疗策略探讨
- Author:
Jia-Feng WANG
1
;
Quan ZHANG
;
Zhu-Ming GUO
;
An-Kui YANG
;
Hao LI
;
Man-Bin XU
Author Information
1. 中山医科大学附属肿瘤防治中心
- Keywords:
Tongue neoplasms;
Carcinoma;
squamous cell;
Lymphatic metastasis;
Neckdissection.
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2009;44(11):921-925
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the related factors of neck recurrence and regularity of cervical lymph nodes metastasis of pathologically node positive(pN+)tongue squamous cell carcinoma(SCC)and explore the neck treatment strategy for pN+ tongue SCC. Methods Clinical and follow-up data of 138patients with pN+ oral tongue SCC from Jan.1991 to Dec.2008 were reviewed. Distribution of neck metastatic and recurrent lymph nodes were analyzed. The influencing factors of neck recnrrence of pN+ tongue SCC were analyzed. Results All patients were followed over two years or until death. Using Kaplan-Meier method, the 3-year and 5-year overall survival rates were 46.4%and 36.2%respectively.Twohundred and three levels of 138 patients had metastasis and the involvement frequency of ipsilateral Ⅰ,Ⅱ,Ⅲreached to 94.6%.Sixty-six levels of 47 patients had neck recurrences and the involvement frequency of ipsilateral Ⅰ,Ⅱ,Ⅲreached to 77.3%.pT stage, pN stage, pTNM stage, extracapsular spread(ECS)of cervical lymph nodes were relevant to the neck recurrence of pN+ tongue SCC(all P＜0.05).When ECS of cervical lymph nodes was present. The neck recurrence rate of patients with postoperative radiation was lower than patients without postoperative radiation. But P value failed to demonstrate significant difference(P=0.076).There were no significant difference of neck recurrence rates between difierent neck dissection methods(P＞0.05).Multivariate Cox analysis showed that pTNM stage and ECS of cervical lymph nodes were the independent prognostic factors of pN+ oral tongue SCC. Conclusions pT stage, pN stage, pTNMstage, ECS of cervical lymph nodes were the influencing factors of neck recurrence of pN+ tongue SCC. Postoperative radiation may reduce the neck recurrence rate when ECS was present. There was no difference of the neck recurrence rate between modified neck dissection(MRND)and radical neck dissection(RED)and when the non-lymphatic structures were not involved, MRND should attempted. Metastatic and recurrent lymph nodes of pN+ tongue SCC were mostly distributed in ipsilateral Ⅰ,Ⅱ,Ⅲ level and selective neck dissection(SND)can be applied to pN+ tongue SCC.
