CAJ | 학술논문

背景与目的:鼻咽痛颈部淋巴结转移不仅影响临床分期及治疗计划,也是影响预后的主要因素之一.本研究旨在探讨鼻咽癌颈淋巴结转移的规律,为临床治疗及研究提供依据.方法:779例经病理证实的首诊鼻咽癌患者,治疗前均行MRI规范扫描,并根据影像学颈部淋巴结分区标准(RTOG2006版N_+为基础)确定淋巴结位置.MRI资料分析由放疗科与影像科医师共同完成.以卡方检验分析不同T分期各区淋巴结转移率的差别及淋巴结不同直径之间包膜受侵的差别,同时分析淋巴结在各区分布特点及跳跃性转移情况.结果:本组患者中有592例(76.O%)出现转移淋巴结,各区分布如下:Ⅰ区Ⅰ例(0.2%),Ⅱ_a区384例(64.9%),Ⅱ_b区499例(84.3%),Ⅲ区184例(31.1%),Ⅳ区33例(5.6%),Ⅴ_a区67例(11.3%),Ⅴ_b区21例(3.5%),咽后597例(76.6%).本组各区最多转移淋巴结共1 479个,其中包膜外侵973个(65.79%),包膜外侵比例随淋巴结直径增大而增大(P=0.000).各区淋巴结转移和T分期之间无明显相关性,跳跃性转移率为1.0%.结论:鼻咽癌Ⅱ区和咽后淋巴结转移率最高,均为前哨淋巴结.Ⅰ区转移率极低.淋巴结包膜外侵比例与最大径正相关.淋巴结很少跳跃性转移,T分期和各区淋巴结转移之间无相关性.
배경여목적:비인통경부림파결전이불부영향림상분기급치료계화,야시영향예후적주요인소지일.본연구지재탐토비인암경림파결전이적규률,위림상치료급연구제공의거.방법:779례경병리증실적수진비인암환자,치료전균행MRI규범소묘,병근거영상학경부림파결분구표준(RTOG2006판N_+위기출)학정림파결위치.MRI자료분석유방료과여영상과의사공동완성.이잡방검험분석불동T분기각구림파결전이솔적차별급림파결불동직경지간포막수침적차별,동시분석림파결재각구분포특점급도약성전이정황.결과:본조환자중유592례(76.O%)출현전이림파결,각구분포여하:Ⅰ구Ⅰ례(0.2%),Ⅱ_a구384례(64.9%),Ⅱ_b구499례(84.3%),Ⅲ구184례(31.1%),Ⅳ구33례(5.6%),Ⅴ_a구67례(11.3%),Ⅴ_b구21례(3.5%),인후597례(76.6%).본조각구최다전이림파결공1 479개,기중포막외침973개(65.79%),포막외침비례수림파결직경증대이증대(P=0.000).각구림파결전이화T분기지간무명현상관성,도약성전이솔위1.0%.결론:비인암Ⅱ구화인후림파결전이솔최고,균위전초림파결.Ⅰ구전이솔겁저.림파결포막외침비례여최대경정상관.림파결흔소도약성전이,T분기화각구림파결전이지간무상관성.
Background and purpose: Cervical nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical staging, it is also one of the main factors influencing prognosis. So this study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which may provide a basis for clinical treatment and research. Methods: From Jun. 2005 to Sep. 2007,779 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiation therapy at Fujian Provincial Cancer Hospital. Diagnostic radiologists and radiation oncoiogists together assessed the nodal distribution according to the guideline CT-hased delineation of lymph node levels. Then, Chi-sqnare test was used to analyze the correlation between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion. Results: Of 779 patients, 592(76.0%) had nodal involvement. The distribution was as follows: 1 in level Ⅰ,384 in level Ⅱa, 499 in level Ⅱ_b, 184 in level Ⅲ, 33 in level Ⅳ, 67 in level V_a, 21 in level V_b, 597 in retropharynx.In these patients, a total of 1 479 postive nodes, including 973 (65.79%) extracapsular spread nodes, were detected.The rate of nodal extracapsular invasion was higher when the axial diameter increased. Leap metastasis rate was 1.0%. No significant correlation was found between T stage and nodal involvement. Conclusion: The level Ⅱ and retropharyngeal node were the most frequently involved regions, they had similar metastatic rate and were both the first echo node to metastases of nasopharyngeal carcinoma. Level Ⅰ metastasis was lower. The proportion of extracapsular spread of metastatic lymph nodes increased with axial diameter of lymph nodes-dependent. The cervical node involvement of nasopharyngeal carcinoma was spread orderly down the neck, and the incidence of skip metastasis is rare. The relationship between T stage and nodal involvement has no statistical significance.