Influence of histopathologic factors on pattern of metastasis in squamous cell carcinoma of the head and neck
Influence of histopathologic factors on pattern of metastasis in squamous cell carcinoma of the head and neck
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DOI：
10.1002/lary.24458
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发表时间：
2014-05-01
期刊：
影响因子：
2.6
通讯作者：
Reinisch, Sabine
中科院分区：
文献类型：
--
作者：
Lanzer, Martin;Gander, Thomas;Reinisch, Sabine
目的/假设了解头颈部鳞状细胞癌患者的组织病理学因素，如神经周围浸润（PNI）、囊外扩散（ECS）、血管淋巴管浸润和聚集性淋巴结，对于做出适当的治疗决策是重要的。鉴于积极的治疗方案与已知的副作用和负担的患者，选择正确的治疗方案是至关重要的。Study DesignRetrospective patient database.MethodsUsing一个回顾性数据库的患者治疗超过10年的时间，独立的无病生存和总生存的预后因素进行了评估。单因素分析用于确定显着的变量，和多变量考克斯回归分析用于确定独立的预后factors.ResultsBetween 1999年1月1日至2009年12月31日，291例头颈部鳞状细胞癌进行了分析，以确定转移模式的组织病理学因素的影响。PNI倾向于在同侧和对侧淋巴结中设置局部转移。淋巴管增生容易导致同侧淋巴结转移。ECS扩散和血管形成显示远处转移的风险显著较高。随着聚集性淋巴结的发生，患者的数据显示了一个非常显着的积累，远处metastasis. ConclusionsPNI和淋巴管浸润患者倾向于局部区域淋巴结转移的同侧颈部。在PNI的情况下，患者有肿瘤对侧颈部复发的风险。在患有ECS、血管侵犯或聚集性疾病的患者中，疾病更有可能扩散到远处，并且对患者的生存具有很高的负面影响。证据等级4喉镜，124：E160-E166，2014
Objectives/HypothesisKnowledge of histopathological factors, such as perineural invasion (PNI), extracapsular spread (ECS), angiolymphatic vessel invasion, and conglomerate lymph nodes, in patients with head and neck squamous cell carcinoma is important for appropriate treatment decisions. Given the availability of aggressive therapeutic options with known side effects and burdens for the patient, choosing the correct treatment option is vital.Study DesignRetrospective patient database.MethodsUsing a retrospective database of patients treated over a 10-year period, independent prognostic factors for disease-free survival and overall survival were assessed. Univariate analysis was used to identify significant variables, and multivariate Cox regression analysis was used to determine independent prognostic factors.ResultsBetween January 1, 1999 and December 31, 2009, 291 patients with head and neck squamous cell carcinoma were analyzed to identify influence of histopathological factors on pattern of metastasis. PNI tends to set metastasis locoregional, both in ipsilateral and contralateral lymph nodes. Lymphangiosis eases the way toward ipsilateral lymph node metastasis. ECS spread and hemangiosis demonstrated a significantly higher risk of distant metastasis. With the occurrence of conglomerate lymph nodes, patient data demonstrated a highly significant accumulation of distant metastasis.ConclusionsPatients with PNI and lymph vessel invasion tend toward locoregional lymph node metastasis on the ipsilateral side of the neck. In cases of PNI, the patient is at risk for a contralateral neck recurrence of the tumor. In patients with ECS, blood vessel invasion, or conglomerate disease, disseminated spread of the disease to distant locations is more likely and has a high negative impact on survival of the patient.Level of Evidence4 Laryngoscope, 124:E160-E166, 2014