淋巴結密度可否作為頰膜癌預後之危險因子？

Lymph Node Density: A Independent Risk Factor in Patients with Buccal Cancer?

林鴻達(Hung-Ta Lin) ； 賴悠仕(Yo-Shih Lai) ； 陳穆寬(Mu-Kuan Chen)

《台灣耳鼻喉頭頸外科雜誌》 48卷1期 (2013/03) Pp. 27-38

https://doi.org/10.6286/2013.48.1.27

摘要

背景：在淋巴結轉移封口腔鱗狀細胞癌患者預後的影響（OSCC）已經被廣泛認可。在我們的研究中，以淋巴節密度作為一個獨立的預後因子針對那些接受過頸淋巴廓清術且呈現陽性淋巴結的口腔癌患者，並與當前的淋巴結分期系統作比較。方法：在這個回溯性研究中我們收集了彰化基督教醫院2004年1月和2008年12月共596例口腔頰膜癌且接受單側或雙側的頸淋巴廓清術的病患進行分析。此外，排除標準包括：1.有其他部位例如唇、臼齒後三角區、口腔底、硬腭及舌前三分之二發生口腔惡性腫瘤者2.接受過術前化療者3.沒有作根治性或功能性頸淋巴廓清術（level 1-5）者4.做雙側頸淋巴廓清術者5.廓清術之淋巴結未呈現陽性反應者6.術前已有遠端轉移者7.資料不全或手術後未追蹤者。排除以上條件不符者，本研究共計收錄了103名病患。結果：自2004年1月到2008年12月之間，符合本研究的病人共計有103名單側頰耳其癌且接受口腔腫瘤切除，併單側根治性或功能性頸淋巴擴清手術且發現有淋巴結呈陽性反應的病人，其中男性102名而女性有1名， 平均年齡約58歲。若以TNM staging system來作分析，T1-2有45名，而T3-4占了58人，N1占了44人，N2占了59人。在此研究中死亡共67人，存活有36人，整體平均追蹤時間為37.611個月，整體區域性淋巴結檢查數目為35.84個，整體平均區域性陽性淋巴結數目為2.67個，淋巴結密度範圍在0.013到0.417之間，平均淋巴結密度為0.092，中位數為0.057。在腫瘤分期（T1-2&T3-4）及淋巴密度上用克氏比例風險迴歸模式分析來做單變數分析，再用多變數分析做調整，都有達統計上明顯的意義。此外，淋巴結密度與無病存活率無論在單變數分析或多變數分析都有達統計上明顯的意義。結論：本研究的主要目的是驗證淋巴結密度是一個很好的評估工具，用於評估頰癌的存活率並結合AJCC淋巴結分期系統作分析。然而，必須排除NO和N3的患者。因為研究中顯示N1和N2組患者似乎有較好的準確性。因此以Tumor-node-metastasis（TNM）淋巴結分期系統作為評估工具，提供醫師更多的預後信息的角色，仍然無法完全被取代。

關鍵字

頸淋巴結密度 ； 頸淋巴廓清術 ； 口腔頰膜癌

並列摘要

BACKGROUND: The impact of lymph node metastases on prognosis in patients with oral cavity squamous cell carcinoma (OSCC) has been well recognized. In our study, we aimed to validate the lymph node ratio (LNR) as an independent prognostic factor in buccal cancer patients who underwent unilaterial neck dissection (ND) with positive lymph node and compare its utility with the current nodal staging system.METHODS: A retrospective chart review was performed of 596 patients with buccal cancer who received a unilateral neck dissection or bilaterial neck dissection in Changhua Christian Hospital between January of 2004 and December of 2008. Besides, The exclusion criteria included (1). perioperative other oral cancer such as tongue, hard palate ,retromolar and mouth floor were noted (2). neoadjuvant chemoradiotherapy (3). underwent bilaterial neck dissection with positive lymph node (4). underwent unilaterial neck dissection without positive lymph node (5). distal metastasis (6). incomplete data or follow-up. The final study population consisted of 103 patients.RESULTS: This study was based on reviews performed on the charts of buccal cancer patients submitted to neck clearance between January of 2004 and December of 2008. A group of 103 patients with lymph node metastases confirmed by histopathology. One hundred and two were males and 1 was female, with a mean age of 58 years. Fourityfive were diagnosed as having stage I and stage II tumors, and 58 had stage III and stage IV tumors. There were 44 patients with pN1disease and 59 patients with pN2 disease. sixty-seven patients died and 36 patients were alive in our study.The followup interval ranged from 2.8 to 98.6 months, with a mean of 37.61 months. Patients had mean 2.67 involved lymph nodes; 35.84 lymph nodes were removed on average patient. Density ranged between 0.013 to 0.417 with mean value of 0.092 and a median of 0.057. The tumor stage (T1-2 &T3-4) and LNR were adjusted by statistically significant and clinicallty relevant covariates in a multivariable Cox proportional hazards regression model. In addition, LNR was strongly statistically associated with Disease free survival in both univariate and multivariate analyses (p = 0.006).CONCLUSIONS: The primary aim of this study was to validate the LNR as a good assessment tool to assess the survival rate of buccal cancer combined with the AJCC nodal staging system. However, patients with N0 and N3 must be excluded for the assessment. Patients with N1 and N2 patients seem to have better accuracy. Therefore the AJCC nodal staging system, providing additional prognostic information that may be useful to the clinician can not be replaced.

並列關鍵字

lymph node density ； neck dissection ； buccal cancer