Occult Nodal Disease Prevalence and Distribution in Recurrent Laryngeal Cancer Requiring Salvage Laryngectomy
Occult Nodal Disease Prevalence and Distribution in Recurrent Laryngeal Cancer Requiring Salvage Laryngectomy
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DOI：
10.1177/0194599815627811
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发表时间：
2016-03-01
影响因子：
3.4
通讯作者：
Spector, Matthew E.
中科院分区：
文献类型：
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作者：
Birkeland, Andrew C.;Rosko, Andrew J.;Spector, Matthew E.
目的颈淋巴清扫术合并喉切除术的适应症在临床上尚不明确。我们的目的是确定隐蔽性淋巴结疾病的患病率，分析淋巴结疾病的分布模式，并确定喉切除术队列中隐蔽性淋巴结疾病的预测因素。研究设计案例系列，计划数据收集。三级学术中心设置。放疗/放化疗失败后持续性或复发性喉鳞状细胞癌（LSCC）患者行喉切除术合并颈部清扫术。方法对1997年至2014年的单机构回顾性病例系列患者进行分析，并确定临床N0 （cN0）颈部患者（n = 203）。收集临床和病理资料，包括淋巴结的患病率和分布，并进行统计分析。结果总体而言，17% （n = 35）的cN0颈部有组织学阳性的隐匿淋巴结。隐匿淋巴结阳性的单因素预测因子包括复发T4期（34% T4 vs 12%非T4， P = 0.0003）和声门上亚位点（28%声门上对10%非声门上，P = 0.0006）。与声门上原发淋巴结相关的组织学阳性淋巴结在同侧II级和III级最常见（17%和16%）。声门LSCC阳性淋巴结最常见于同侧和对侧气管旁淋巴结（分别为11%和9%）。结论17%的cN0患者行保留性喉切除术合并颈部清扫术可发现组织学阳性的隐匿淋巴结。隐匿性淋巴结疾病的发生频率和分布因肿瘤亚位的不同而不同。高（>20%）隐匿淋巴结阳性的预测因子包括T4肿瘤和声门上亚位。在声门LSCC中，隐匿淋巴结疾病最常见的部位是气管旁淋巴结盆地。
Objectives The indications for neck dissection concurrent with salvage laryngectomy in the clinically N0 setting remain unclear. Our goals were to determine the prevalence of occult nodal disease, analyze nodal disease distribution patterns, and identify predictors of occult nodal disease in a salvage laryngectomy cohort.Study Design Case series with planned data collection.Setting Tertiary academic center.Subjects Patients with persistent or recurrent laryngeal squamous cell carcinoma (LSCC) after radiation/chemoradiation failure undergoing salvage laryngectomy with neck dissection.Methods We analyzed a single-institution retrospective case series of patients between 1997 and 2014 and identified those who had clinically N0 (cN0) necks (n = 203). Clinical and pathologic data, including nodal prevalence and distribution, were collected and statistical analyses performed.Results Overall, cN0 necks had histologically positive occult nodes in 17% (n = 35) of cases. Univariate predictors of occult nodal positivity included recurrent T4 stage (34% T4 vs 12% non-T4; P = .0003) and supraglottic subsite (28% supraglottic vs 10% nonsupraglottic; P = .0006). Histologically positive nodes associated with supraglottic primaries were most frequently positive in ipsilateral levels II and III (17% and 16%). Positive nodes for glottic LSCC were most frequently positive in the ipsilateral and contralateral paratracheal nodes (11% and 9%).Conclusion Histologically positive occult nodes are identified in 17% of cN0 patients undergoing salvage laryngectomy with neck dissection. Occult nodal disease varies in frequency and distribution based on tumor subsite. Predictors of high (>20%) occult nodal positivity include T4 tumors and supraglottic subsite. In glottic LSCC, the most frequent sites of occult nodal disease are the paratracheal nodal basins.