THE PROGNOSTIC-SIGNIFICANCE OF LYMPH-NODE INVOLVEMENT IN PYRIFORM SINUS AND SUPRAGLOTTIC CANCERS
THE PROGNOSTIC-SIGNIFICANCE OF LYMPH-NODE INVOLVEMENT IN PYRIFORM SINUS AND SUPRAGLOTTIC CANCERS
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DOI：
10.1016/0360-3016(87)90186-6
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发表时间：
1987-08-01
影响因子：
7
通讯作者：
CONSTABLE, WC
中科院分区：
文献类型：
--
作者：
HAHN, SS;SPAULDING, CA;CONSTABLE, WC
本文回顾了333例梨状窝癌或声门上癌的淋巴结转移和预后。所有患者均接受了根治性治疗，至少随访3年。根据AJCC 1983年的建议，对每例患者进行了再分期。此外，淋巴结固定到颈部筋膜或肌肉的预后进行了评估。75%（89/119）的梨状窝癌和47%（101/214）的声门上型喉癌患者可触及颈部淋巴结。N分期N 0、N1、N2、N3分别为143例（43%）、84例（25%）、58例（17%）、48例（14%）。在有淋巴结固定信息的患者中，29%的患者有固定的淋巴结。N 0和N1或N2和N3期之间的预后没有差异，因此将这些组合并。T1（N 0/N1）、T2（N 0/N1）、T3（N 0/N1）和T4（N 0/N1）病例的3年生存率分别为85%、77%、63%和65%，而T1（N2/N3）、T2（N2/N3）和T3（N2/N3）病例的3年生存率分别为19%、34%和33%，T_4（N_2/N_3）期占32%，说明N期生存率高于T期。局部复发和远处转移均随N分期的进展而增加。在颈部复发（35%对17%）、远处转移（33%对19%）和生存率（27%对58%）方面，固定淋巴结和移动的淋巴结患者之间存在显著差异。总之，在梨状窝和声门上癌中，淋巴结分期是独立于T分期的生存率的一个非常重要的决定因素。与N2、N3状态和固定相比，N 0、N1状态和活动性预测预后良好。当梨状窝癌和声门上癌分别分析时，这些发现是一致的。
Three hundred and thirty-three patients with carcinoma of the pyriform sinus or supraglottis were reviewed with regard to lymph node involvement and prognosis. All patients were treated with curative intent and had a minimum follow-up of 3 years. Every patient was restaged according to the AJCC, 1983 recommendations. In addition, nodal fixation to cervical fascia or muscle was evaluated with regard to prognosis. Seventy-five percent (89/119) of the pyriform sinus cancer and 47% (101/214) of the supraglottic cancer patients presented with clinically palpable cervical nodes. The distribution of patients according to N stage was 143 (43%), 84 (25%), 58 (17%), 48 (14%) for N0, N1, N2, N3 respectively. In patients where information on nodal fixation was available, 29% had fixed nodes. No difference in prognosis was noted between N0 and N1 or N2 and N3 stages, and these groups were therefore combined. The 3-year survival was 85% for T1 (N0/N1), 77% for T2 (N0/N1), 63% for T3 (N0/N1), and 65% for T4 (N0/N1) cases compared to 19% for T1 (N2/N3), 34% for T2 (N2/N3), 33% for T3 (N2/N3), and 32% for T4 (N2/N3) cases demonstrating that N stage predominates over T stage with respect to survival. Both the local recurrences and distant metastases increased as N stage advanced. A noteworthy difference between patients with fixed nodes and mobile nodes was found with regard to neck recurrence (35% versus 17%), distant metastases (33% versus 19%) and survival (27% versus 58%). In conclusion, nodal stage is a highly significant determinant of survival independent of T stage in cancers of the pyriform sinus and supraglottis. N0, N1 status and mobility were predictive of a favorable prognosis as opposed to N2, N3 status and fixation. These findings were consistent when the pyriform sinus cancers and supraglottic cancers were analyzed separately.