CAJ | 학술논문

背景与目的：对于喉癌患者是否常规行颈部中央区淋巴结清扫，目前尚存在争议。本研究探讨喉癌患者中央区和侧颈区淋巴结转移、颈部复发以及疾病预后生存情况。方法：回顾性分析1999-2009年复旦大学附属肿瘤医院收治的118例确诊为喉癌患者的临床病理资料。其中34例患者行颈部中央区淋巴结清扫。回顾分析肿瘤原发灶分级，中央区和侧颈区淋巴结转移临床资料，以及患者总生存率(overall survival, OS)，无病生存率(diseas-free survival, DFS)和局控率(local control rate, LCR)。结果：在118例喉癌患者中，颈部中央区淋巴结转移率为11.9%(14/118)，包括在34例中央区淋巴结清扫患者中证实10例，未作淋巴结清扫，在随访中发现中央区淋巴结转移4例。肿瘤声门下或者梨状窝侵犯是中央区转移以及中央区复发的危险因素(P=0.002)。中央区淋巴结转移与颈部IV区转移相关(P<0.001)，侧颈区淋巴结包膜外侵犯(P=0.001)和血管侵犯(P=0.015)是中央区淋巴结转移、中央区复发和颈侧区复发的危险因素。中央区淋巴结转移阳性喉癌患者较阴性患者局控率低(P=0.035)。侧颈区淋巴结转移阳性患者较阴性患者无病生存率(P=0.014)和局控率(P=0.025)低。声门上喉癌更容易发生颈部Ⅱ区淋巴结转移(P=0.044)。结论：喉癌患者应注意中央区淋巴结清扫。声门上喉癌患者应注意颈部Ⅱ区淋巴结清扫。中央区淋巴结转移阳性患者应注意颈部Ⅳ区淋巴结清扫。
배경여목적：대우후암환자시부상규행경부중앙구림파결청소，목전상존재쟁의。본연구탐토후암환자중앙구화측경구림파결전이、경부복발이급질병예후생존정황。방법：회고성분석1999-2009년복단대학부속종류의원수치적118례학진위후암환자적림상병리자료。기중34례환자행경부중앙구림파결청소。회고분석종류원발조분급，중앙구화측경구림파결전이림상자료，이급환자총생존솔(overall survival, OS)，무병생존솔(diseas-free survival, DFS)화국공솔(local control rate, LCR)。결과：재118례후암환자중，경부중앙구림파결전이솔위11.9%(14/118)，포괄재34례중앙구림파결청소환자중증실10례，미작림파결청소，재수방중발현중앙구림파결전이4례。종류성문하혹자리상와침범시중앙구전이이급중앙구복발적위험인소(P=0.002)。중앙구림파결전이여경부IV구전이상관(P<0.001)，측경구림파결포막외침범(P=0.001)화혈관침범(P=0.015)시중앙구림파결전이、중앙구복발화경측구복발적위험인소。중앙구림파결전이양성후암환자교음성환자국공솔저(P=0.035)。측경구림파결전이양성환자교음성환자무병생존솔(P=0.014)화국공솔(P=0.025)저。성문상후암경용역발생경부Ⅱ구림파결전이(P=0.044)。결론：후암환자응주의중앙구림파결청소。성문상후암환자응주의경부Ⅱ구림파결청소。중앙구림파결전이양성환자응주의경부Ⅳ구림파결청소。
Background and purpose: The aim of this study was to determine the necessity of central compartment neck dissection in laryngeal cancer.Study Design: Retrospective study at a tertiary referral medical center. Methods:Patients with laryngeal squamous cell cancer who underwent neck dissection were evaluated, and a retrospective analysis of clinicopathologic factors and follow-up data were performed. Results: One hundred and eighteen patients from 1999 to 2009 were enrolled. There were 11.9% central compartment lymph node metastasis in all patients, including the 10 patients with central compartment lymph node metastasis in 34 patients underwent compartment neck dissection and 4 patients do not underwent compartment neck dissection but had central neck recurrence in the follow up time. Subglottic or pyriform extension were risk factors in central compartment lymph node metastasis and central neck recurrence (P=0.002). Central compartment lymph node metastasis had closed relationship with levelⅣmetastasis (P<0.001), extracapsular extension (P=0.001), vascular extension (P=0.015) and poor local control rates (P=0.035) respectively. Patients who were positive for lateral neck lymph node metastasis had poor disease-free survival rate (P=0.014) and poor local control rates (P=0.025), and supraglottic cancer had a trend to metastases to levelⅡ(P=0.044). Conclusion:Central compartment neck dissection might be considered a potential therapeutic approach for patients with laryngeal cancer.