{"title":"[The analysis of unconventional lymph node metastasis in tongue squamous cell carcinoma].","authors":"K Wu, B W Dai, H J Wu","doi":"10.3760/cma.j.cn115330-20231204-00266","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objective:</b> To analyze the characteristics of cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). <b>Methods:</b> A retrospective study was conducted. A total of 329 patients with TSCC who underwent en bloc resection of primary tumor and neck dissection in the Second Xiangya Hospital of Central South University from June 2010 to March 2018 were included. There were 283 males and 46 females, aged from 26 to 80 years. All patients underwent the modified neck dissection. The main difference between the modified neck dissection and the traditional neck dissection lay in the managements of unconventional lymph nodes. The lymphatic adipose tissues adjacent to the superior thyroid artery, the base of facial artery and the branches of external carotid artery were thoroughly dissected. The primary tumor as well as lingual artery, tissues along the lingual artery and lymph nodes in the mouth floor were resected. χ<sup>2</sup> test was used for comparison of count data, and linear regression model was used for multivariate analysis. <b>Results:</b> Cervical lymph node metastases were found in 136 patients (41.3%). Among 142 patients (T1-2cN0) with supraomohyoid neck dissection, 22 patients had pathologically occult lymph node metastases (15.5%), with a 5-year overall survival rate of 90.2%, which was similar to the 5-year overall survival rate of 92.1% in 120 patients without lymph node metastasis (χ<sup>2</sup>=0.156, <i>P</i>=0.693). Multivariate linear regression analysis showed that T stage, clinical stage and unconventional lymph node metastasis were important factors for cervical lymph node metastasis in tongue cancer patients (<i>P</i><0.05). Unconventional lymph node metastases occurred in 30 patients (9.1%), including the metastases of lymph nodes in the floor of mouth (3.0%), the lingual artery (2.4%), the base of the external maxillary artery (2.1%), the superior thyroid artery (0.9%), and the external carotid artery (0.6%). There were significant differences in the unconventional lymph node metastasis rates between patients with negative and positive conventional lymph node metastases [4.9%(10/203) <i>vs.</i> 15.9%(20/126), χ<sup>2</sup>=11.242, <i>P</i>=0.001] and also between patients with depth of invasion ≤5 mm, 5 mm <depth of invasion ≤10 mm or depth of invasion >10 mm [3.1%(2/64) <i>vs.</i> 5.7%(6/106) <i>vs.</i> 13.8%(22/159), χ<sup>2</sup>=7.907, <i>P</i>=0.005]. <b>Conclusion:</b> Supraomohyoid neck dissection can achieve reliable control efficacy in patients with cN0 tongue cancer. All patients with lymph node dissection should undergo unconventional lymph node dissection. Unconventional lymph node dissection is strongly recommended for patients with conventional lymph node metastasis.</p>","PeriodicalId":23987,"journal":{"name":"Chinese journal of otorhinolaryngology head and neck surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chinese journal of otorhinolaryngology head and neck surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/cma.j.cn115330-20231204-00266","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To analyze the characteristics of cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). Methods: A retrospective study was conducted. A total of 329 patients with TSCC who underwent en bloc resection of primary tumor and neck dissection in the Second Xiangya Hospital of Central South University from June 2010 to March 2018 were included. There were 283 males and 46 females, aged from 26 to 80 years. All patients underwent the modified neck dissection. The main difference between the modified neck dissection and the traditional neck dissection lay in the managements of unconventional lymph nodes. The lymphatic adipose tissues adjacent to the superior thyroid artery, the base of facial artery and the branches of external carotid artery were thoroughly dissected. The primary tumor as well as lingual artery, tissues along the lingual artery and lymph nodes in the mouth floor were resected. χ2 test was used for comparison of count data, and linear regression model was used for multivariate analysis. Results: Cervical lymph node metastases were found in 136 patients (41.3%). Among 142 patients (T1-2cN0) with supraomohyoid neck dissection, 22 patients had pathologically occult lymph node metastases (15.5%), with a 5-year overall survival rate of 90.2%, which was similar to the 5-year overall survival rate of 92.1% in 120 patients without lymph node metastasis (χ2=0.156, P=0.693). Multivariate linear regression analysis showed that T stage, clinical stage and unconventional lymph node metastasis were important factors for cervical lymph node metastasis in tongue cancer patients (P<0.05). Unconventional lymph node metastases occurred in 30 patients (9.1%), including the metastases of lymph nodes in the floor of mouth (3.0%), the lingual artery (2.4%), the base of the external maxillary artery (2.1%), the superior thyroid artery (0.9%), and the external carotid artery (0.6%). There were significant differences in the unconventional lymph node metastasis rates between patients with negative and positive conventional lymph node metastases [4.9%(10/203) vs. 15.9%(20/126), χ2=11.242, P=0.001] and also between patients with depth of invasion ≤5 mm, 5 mm 10 mm [3.1%(2/64) vs. 5.7%(6/106) vs. 13.8%(22/159), χ2=7.907, P=0.005]. Conclusion: Supraomohyoid neck dissection can achieve reliable control efficacy in patients with cN0 tongue cancer. All patients with lymph node dissection should undergo unconventional lymph node dissection. Unconventional lymph node dissection is strongly recommended for patients with conventional lymph node metastasis.
目的:分析舌鳞状细胞癌(TSCC)颈淋巴结转移的特征:分析舌鳞状细胞癌(TSCC)颈淋巴结转移的特征。方法:进行回顾性研究:进行回顾性研究。共纳入2010年6月至2018年3月在中南大学湘雅二医院接受原发肿瘤全切术和颈部清扫术的329例TSCC患者。其中男性283例,女性46例,年龄在26岁至80岁之间。所有患者均接受了改良颈部离断术。改良颈部清扫术与传统颈部清扫术的主要区别在于对非常规淋巴结的处理。甲状腺上动脉、面动脉基部和颈外动脉分支附近的淋巴脂肪组织被彻底切除。切除了原发肿瘤、舌动脉、舌动脉沿线组织和口底淋巴结。计数资料比较采用χ2检验,多变量分析采用线性回归模型。结果136例患者(41.3%)发现颈淋巴结转移。在142例颈部上腔静脉清扫术患者(T1-2cN0)中,有22例患者(15.5%)出现病理隐匿性淋巴结转移,5年总生存率为90.2%,与120例无淋巴结转移患者的5年总生存率92.1%相似(χ2=0.156,P=0.693)。多变量线性回归分析显示,T分期、临床分期和非常规淋巴结转移是舌癌患者颈淋巴结转移的重要因素(Pvs.15.9%(20/126),χ2=11.242,P=0.001],在浸润深度≤5 mm、5 mm 10 mm的患者之间也是如此[3.1%(2/64) vs. 5.7%(6/106) vs. 13.8%(22/159), χ2=7.907,P=0.005]。结论颈部淋巴结清扫术可为cN0舌癌患者带来可靠的控制疗效。所有进行淋巴结清扫的患者都应进行非常规淋巴结清扫。对于常规淋巴结转移的患者,强烈建议进行非常规淋巴结清扫术。