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目的 探讨舌体鳞癌cN0 患者的颈部处理。方法 舌体鳞状细胞癌共 1 85例 ,男性 1 0 2例 ,女性 83例 ,年龄 2 8～ 88岁。所有病例均行原发灶手术切除 +颈淋巴清扫术。原发灶及颈淋巴结全部术后病理证实。结果 Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者颈淋巴结转移率分别为 1 6 66 %和 38 0 5 % ;1 4 8例cN0 患者鳞癌Ⅰ级和Ⅱ级颈淋巴结转移率分别为 1 7 42 %和 37 50 % ;原发灶侵及粘膜下层、肌层和神经者 ,其颈淋巴结转移率分别为 9 0 0 %、31 37%和 55 55 %。 1 85例患者 5年生存率为 72 43 % ,其中颈淋巴有转移和无转移者 5年生存率分别为 44 44%、83 96 %。 1 4 8例cN0 患者颈淋巴结阳性者 2 9例 ,其转移区 :下颌下 +颏下 (Ⅰ )占 2 2 64 % ,颈深上 (Ⅱ )占 35 84% ,颈深中 (Ⅲ )占 2 6 40 % ,颈深下(Ⅳ )为 1 5 0 9% ,颈后 (Ⅴ )为 0 %。选择性颈淋巴清扫术 5年生存率为 85 1 3 % ,治疗性为 2 1 62 %(χ2 =2 9 73 ,P <0 0 1 )。选择性颈淋巴清扫术病例中 ,有淋巴结转移 5年生存率为 68 96 % ,未见淋巴结转移者 5年生存率为 89 0 7%。选择性颈淋巴清扫术有淋巴结转移 5年生存率为 68 96 % ,而治疗性有淋巴结转移 5年生存率仅 2 0 0 % (P <0 0 1 )。结论 ①cN0 患者除早期 (Ⅰ期 )可行颈部观察 ,Ⅱ～Ⅳ期须?
Objective To investigate the neck treatment of tongue squamous cell carcinoma of cN0 patients. Methods A total of 1 85 cases of tongue squamous cell carcinoma were found, including 102 males and 83 females, ranging in age from 28 to 88 years. All cases underwent primary tumor resection + neck dissection. All the primary lesions and cervical lymph nodes were confirmed by pathology. Results The rates of cervical lymph node metastases in stage Ⅰ ~ Ⅱ and stage Ⅲ ~ Ⅳ were 166% and 385%, respectively. The metastatic rate of cervical lymph nodes in stage Ⅰ and Ⅱ of 148 cases with cN0 was 1 742% And 37 50% respectively. The rate of cervical lymph node metastasis in the primary tumor invaded the submucosa, muscularis and nerves was 90%, 31 37% and 55 55% respectively. The 5-year survival rate of 855 patients was 72.43%. The 5-year survival rate of cervical lymph nodes with and without metastasis was 44.44% and 83.96% respectively. There were 29 cases of cervical lymph node positive in 148 cases of cN0 patients. The metastatic areas were submandibular and submental (22.6%), neck depth (35.24%) and neck depth (Ⅲ) 26 40%, neck depth (IV) was 150.9% and neck (V) was 0%. The 5-year survival rate of selective neck dissection was 85 1 3%, and the therapeutic effect was 2 1 62% (χ 2 = 2 9 73, P 0 01). In the case of selective cervical lymph node dissection, the 5-year survival rate of lymph node metastasis was 68.96%, and the 5-year survival rate of patients with no lymph node metastasis was 89.07%. The 5-year survival rate of selective neck dissection with lymph node metastasis was 68.96%, while the 5-year survival rate of therapeutic lymph node metastasis was only 200% (P <0.01). Conclusion ①CN0 patients except early (stage Ⅰ) feasible neck observation, Ⅱ ~ Ⅳ period?