摘要
目的探讨舌癌颈淋巴结转移的临床特点,为临床治疗提供参考。方法回顾265例舌癌患者的临床资料,根据术前发病时间、肿物大小、肿瘤部位、TNM分类、肿瘤类型、CT表现特点和颈淋巴结转移情况进行分析。结果 265例舌癌患者术后证实颈淋巴结转移者54例。舌鳞状细胞癌260例,其中舌高分化鳞状细胞癌181例,转移11例(6.1%);舌中分化鳞状细胞癌71例,转移35例(49.3%);舌低分化鳞状细胞癌8例,转移5例(62.5%),不同分化程度舌癌转移率差异具有统计学意义(χ2=69.68,P<0.001),低分化(χ2=63.834,P<0.001)、中分化(χ2=24.615,P<0.001)比高分化转移机会大,差异有统计学意义。舌黏液表皮样癌2例,同侧Ⅰ区淋巴结转移1例(50%);舌平滑肌肉瘤1例,同侧颌下淋巴结转移;舌基底细胞癌1例,无淋巴结转移;舌肉瘤样癌1例,同侧Ⅲ区淋巴结转移。不同部位肿瘤转移率差异有统计学意义(χ2=32.76,P<0.001)。肿物位于舌前缘187例,转移21例(11.2%);位于舌中后份78例,转移33例(42.3%),其中双侧63例中转移35例(55.6%)。临床分期,0期2例,Ⅰ期18例,Ⅱ期180例,Ⅲ期33例,Ⅳ期32例;术前作CT检查185例,提示淋巴结直径大于1.0 cm 15例,转移7例,转移率46.6%(7/15),对87例病灶大小判断较模糊。结论舌癌术后颈淋巴结转移与肿瘤部位、大小、分化程度、肿瘤类型密切相关,CT检查对颈淋巴结评估价值不大,舌癌手术方式应主要根据肿瘤类型、部位、大小、分化程度综合考虑。
Objective To obtain proper treatment strategies by analyzing the clinical features of lingual cancer with post-surgery pathological confirmed cervical lymph node metastasis. Methods Retrospective correlational analysed the clinical features of 265 cases of lingual cancer, including tumor onset time, tumor size. tumor site, clinical TNM stage, pathological classification and differentiation, CT impression, et al. and pathological confirmed cervical lymph node me- tastasis. Results Fifty-four cases of 265 lingual cancer were pathologically confirmed as cervical lymph node metastasis. In 260 cases of lingual squamous cell carcinoma, 11/181 cases of high differentiation squamous cell carcinoma （6.1% ） , 35/71 cases of moderately differentiation squamous cell carcinoma （49.3%） , 5/8 eases of low differentiation squamous cell carcinoma （62.5%） were pathologically confirmed as cervical lymph node metastasis. One of 2 cases of high differentiation mucoepidermoid carcinoma was pathologically confirmed as ipsilateral submaxillary lymph node metastasis （50.0%）. One case of leiomyosarcoma was pathologically confirmed as ipsilateral submaxillary lymph node metastasis （ 100% ）. One case of basal cell carcinoma was pathologically confirmed as no lymph node metastasis （0%）. One case of sarcomatoid carcinoma was pathologically confirmed as level m cervical lymph node metastasis （ 100% ）. In all 265 cases of ling＇ual cancer, 0% Tis stage （0/2） , 14.3% T1 stage （3/21）, 15.5% T2 stage （33/213） , 55.0% T3 stage （11/20） and 77.7% T4 stage （7/9） cases were pathologically confirmed as cervical lymph node metastasis. N1 stage 25 cases, N2a stage 3 cases, N2b stage 16 cases, N2c stage 8 cases, N3 stage 2 cases were pathologically confirmed as cervical lymph node metastasis. Clinical grade 0 2 cases, Clinical grade I 18 cases, Clinical grade Ⅱ 180 cases, Clinical grade Ⅲ 33 cases were pathologically confirmed as cervical lymph node metastasis. One hundred and eighty-seven cases sited in tbre part of the lingual, 21/187 cases pathological confirmed cervical lymph node metastasis （11% ） ; 33/78 cases sited in latter part of the lingual were pathologically confirmed as cervical lymph node metastasis （42%） ; 63 cases were found bilateral lymph node swell in surgery, and 35/63 cases were pathologically confirmed as bilateral cervical lymph nede metastasis （55.5%） ; 185 cases of lingual cancer had head and neck CT scan pre surgery, 15 cases were found lymph node diameter ≥ 1 cm on CT impression, 7 cases were pathologically confirmed as bilateral cervical lymph node metastasis post-surgery （46.6%）. The actual tumor size of 87 cases were not consistent with CT impression. The average time from tumor onset to presentation was 3 months. Conclusion Post surgery pathological confirmed cervical lymph node metastasis is closely correlated with tumor size, tumor site, pathological classification and differentiation. Tumor onset time is not closely correlated with post-surgery pathological confirmed cervical lymph node metastasis. Pre surgery head and neck CT scan has no significant value on the evaluation of cervical lymph node metastasis. Proper treatment strategies selection of lingual cancer should refer to tumor size, tumor site, pathological classification and differentiation.
出处
《广东牙病防治》
2013年第9期461-464,共4页
Journal of Dental Prevention and Treatment
关键词
舌癌
颈淋巴结
淋巴转移
CT
Lingual cancer
Cervical lymph node
Lymph node metastasis
CT
