中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2013年
1期
32-36
,共5页
楼建林%郭良%赵坚强%王升晔
樓建林%郭良%趙堅彊%王升曄
루건림%곽량%조견강%왕승엽
肿瘤,未知原发灶%淋巴转移%癌,鳞状细胞%颈淋巴结清扫术
腫瘤,未知原髮竈%淋巴轉移%癌,鱗狀細胞%頸淋巴結清掃術
종류,미지원발조%림파전이%암,린상세포%경림파결청소술
Neoplasms,unknown primary%Lymphatic metastasis%Carcinoma,squamous cell%Neck dissection
目的 分析原发灶不明颈部淋巴结转移性鳞状细胞癌(squamous cell carcinoma of cervical lymph nodes from an unknown primary site,SCCUP)的治疗方法与预后.方法 回顾分析2001年1月至2011年12月的125例SCCUP患者的临床资料、治疗策略和随访结果.125例患者中共97例次接受颈淋巴清扫手术治疗,72例次接受放疗,51例次接受化疗.46例患者行Ⅰ～V区颈淋巴清扫,43例行Ⅱ～V区清扫,3例行Ⅱ～Ⅵ区清扫,1例行Ⅰ～Ⅵ区清扫,4例行Ⅰ～Ⅲ区清扫.放射治疗中行扩大野照射36例,双侧颈部照射15例,单侧颈部照射21例.使用SPSS16.0统计软件包建立数据库,生存分析采用Kaplan-Meier法,Log-rank检验,采用Cox回归模型进行多因素分析.组间差异采用X2检验,影响颈部复发或未控的多因素分析采用Logistic回归分析.结果 全组5年总生存率为66.2％,5年无瘤生存率60.0％,中位生存期为70个月.Cox分析显示影响生存率的因素有N分级、淋巴结包膜外侵、双侧颈淋巴转移和颈淋巴清扫手术治疗.25例(20.0％)患者出现颈部复发或未控,Logistic回归分析显示N分级是影响颈部复发或未控的主要因素.本组中27例(21.6％)患者在治疗3 ～ 96个月(中位时间15个月)后出现原发灶,其中扩大野放疗的36例中有4例(11.1％)出现原发灶.结论 N分级、淋巴结包膜外侵和颈淋巴清扫手术是影响SCCUP患者生存的主要因素.N分级是影响颈部复发或未控的独立危险因素.颈淋巴清扫手术对颈部淋巴结控制率较高,并且可提高患者生存率.
目的 分析原髮竈不明頸部淋巴結轉移性鱗狀細胞癌(squamous cell carcinoma of cervical lymph nodes from an unknown primary site,SCCUP)的治療方法與預後.方法 迴顧分析2001年1月至2011年12月的125例SCCUP患者的臨床資料、治療策略和隨訪結果.125例患者中共97例次接受頸淋巴清掃手術治療,72例次接受放療,51例次接受化療.46例患者行Ⅰ～V區頸淋巴清掃,43例行Ⅱ～V區清掃,3例行Ⅱ～Ⅵ區清掃,1例行Ⅰ～Ⅵ區清掃,4例行Ⅰ～Ⅲ區清掃.放射治療中行擴大野照射36例,雙側頸部照射15例,單側頸部照射21例.使用SPSS16.0統計軟件包建立數據庫,生存分析採用Kaplan-Meier法,Log-rank檢驗,採用Cox迴歸模型進行多因素分析.組間差異採用X2檢驗,影響頸部複髮或未控的多因素分析採用Logistic迴歸分析.結果 全組5年總生存率為66.2％,5年無瘤生存率60.0％,中位生存期為70箇月.Cox分析顯示影響生存率的因素有N分級、淋巴結包膜外侵、雙側頸淋巴轉移和頸淋巴清掃手術治療.25例(20.0％)患者齣現頸部複髮或未控,Logistic迴歸分析顯示N分級是影響頸部複髮或未控的主要因素.本組中27例(21.6％)患者在治療3 ～ 96箇月(中位時間15箇月)後齣現原髮竈,其中擴大野放療的36例中有4例(11.1％)齣現原髮竈.結論 N分級、淋巴結包膜外侵和頸淋巴清掃手術是影響SCCUP患者生存的主要因素.N分級是影響頸部複髮或未控的獨立危險因素.頸淋巴清掃手術對頸部淋巴結控製率較高,併且可提高患者生存率.
목적 분석원발조불명경부림파결전이성린상세포암(squamous cell carcinoma of cervical lymph nodes from an unknown primary site,SCCUP)적치료방법여예후.방법 회고분석2001년1월지2011년12월적125례SCCUP환자적림상자료、치료책략화수방결과.125례환자중공97례차접수경림파청소수술치료,72례차접수방료,51례차접수화료.46례환자행Ⅰ～V구경림파청소,43례행Ⅱ～V구청소,3례행Ⅱ～Ⅵ구청소,1례행Ⅰ～Ⅵ구청소,4례행Ⅰ～Ⅲ구청소.방사치료중행확대야조사36례,쌍측경부조사15례,단측경부조사21례.사용SPSS16.0통계연건포건립수거고,생존분석채용Kaplan-Meier법,Log-rank검험,채용Cox회귀모형진행다인소분석.조간차이채용X2검험,영향경부복발혹미공적다인소분석채용Logistic회귀분석.결과 전조5년총생존솔위66.2％,5년무류생존솔60.0％,중위생존기위70개월.Cox분석현시영향생존솔적인소유N분급、림파결포막외침、쌍측경림파전이화경림파청소수술치료.25례(20.0％)환자출현경부복발혹미공,Logistic회귀분석현시N분급시영향경부복발혹미공적주요인소.본조중27례(21.6％)환자재치료3 ～ 96개월(중위시간15개월)후출현원발조,기중확대야방료적36례중유4례(11.1％)출현원발조.결론 N분급、림파결포막외침화경림파청소수술시영향SCCUP환자생존적주요인소.N분급시영향경부복발혹미공적독립위험인소.경림파청소수술대경부림파결공제솔교고,병차가제고환자생존솔.
Objective To analyze the treatment strategies and prognosis of squamous cell carcinoma of cervical lymph nodes from an unknown primary site (SCCUP).Methods A total of 125 cases with SCCUP was retrospectively analyzed from January 2001 to December 2011.Ninety-seven of the cases were treated with neck dissection (ND),including 24 with classic radical ND,62 with modified ND and 11 with extended radical ND.Of 125 cases with SCCUP,72 cases were supplemented with radiotherapy and 52 cases with chemotherapy.Radiotherapy was applied with extensive field in 36 cases,bilateral neck in 15 cases,and ipsilateral neck in 21 cases.The patients were followed up and the Kaplan-Meier method was used to calculate survival curves.Cox's analysis and logistic regression were used to evaluate the prognosis factors for SCCUP.Results The 5-year overall survival rate and disease free survival rate of the cohort were 66.2％ and 60.0％,respectively.The median survival time was 70 months.Cox's analysis showed N-stage,extracapsular spread,bilateral neck metastasis and ND were independent prognostic factors for SCCUP.Logistic regression suggested that N-stage was the main factor for nodal recurrence or uncontrolled.The primary tumor sites emerged in 27 patients (21.6％)within 3-96 months after treatment (median time was 15 months),but only 4 patients (11.1％) existed in 36 cases underwent radiotherapy with extensive field.Conclusions N-stage and extracapsular spread are two major factors influencing the prognosis of SCCUP.ND may improve the locoregional control and long-term survival.
