Extracapsular spread in the clinically negative neck (NO): Implications and outcome
Extracapsular spread in the clinically negative neck (NO): Implications and outcome
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DOI：
10.1016/s0194-5998(96)70285-1
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发表时间：
1996-01-01
影响因子：
3.4
通讯作者：
Johnson, JT
中科院分区：
文献类型：
--
作者：
Alvi, A;Johnson, JT
颈部转移是头颈癌患者最重要的预后因素，转移淋巴结中肿瘤向包膜外扩散的预后意义也已被证实。包膜外扩散的存在进一步使宫颈转移性疾病患者的生存率降低了50%，大多数临床阴性颈部（NO期）的患者预后良好，然而，其中一些患者会出现颈部疾病和远处转移，最终死亡。因为包膜外扩散的存在是预后不良的预测因素，我们假设包膜外扩散可能是临床阴性颈部患者预后不良的一个因素。鉴定出 109 名临床阴性颈部接受颈清扫术的患者，34% 的患者观察到隐匿性转移，在该组中 18 名 (49%) 患者出现包膜外扩散。总体而言，103 名患者进行了评估，其中 70 名患者 (68%) 在治疗 2 年后或更长时间内保持无病状态。一个由 68 名患者组成的亚组具有组织学阴性淋巴结，其中 56 名 (82%) 没有疾病。在囊外扩散的患者中，16 名中只有 5 名 (31%) 没有疾病。这与转移仅限于淋巴结的患者形成鲜明对比，其中 19 名患者中有 9 名 (47%) 没有疾病。这些数据的统计分析表明，对于这个样本量，这种差异是显着的。增加放射治疗并没有改善这些患者的结果。包膜外扩散预示亚临床宫颈转移患者的结果会更差。由于囊外扩散患者术后放疗效果不佳，因此建议采用其他辅助治疗模式。
Cervical metastasis is the most important prognostic factor in head and neck cancer patients, The prognostic significance of extracapsular spread of tumor in metastatic lymph nodes has also been documented. The presence of extracapsular spread further reduces the survival by 50% in those patients with cervical metastatic disease, Most patients with clinically negative necks (stage NO) have a good prognosis, However, some of these patients will have neck disease and distant metastasis and will eventually die, Because the presence of extracapsular spread is a predictor of poor outcome, we hypothesized that extracapsular spread may be a factor in the subset of patients with clinically negative necks who have poor outcomes. One hundred nine patients with clinically negative necks who had undergone neck dissection were identified, Occult metastasis was observed in 34% of patients, In this group, extracapsular spread was present in 18 (49%) patients. Overall, 103 patients were evaluable, of whom 70 (68%) remain free of disease 2 or more years after treatment. A subgroup of 68 patients had histologically negative nodes, of whom 56 (82%) are free of disease, Of patients with extracapsular spread, only 5 (31%) of 16 are free of disease. This is in contrast to patients with metastasis confined to the lymph node, of whom 9 (47%) of 19 are free of disease, Statistical analysis of these data shows that for this sample size this difference is significant, The addition of radiation therapy did not improve outcome in these patients, Extracapsular spread predicts a worse outcome in patients with subclinical cervical metastasis. Alternative modes of adjuvant therapy are suggested because of the poor results of postoperative radiation therapy in patients with extracapsular spread.