Lymphatic metastasis and failure patterns in laryngeal squamous cell carcinoma after surgery

doi:10.3877/cma.j.issn.1674-0785.2020.10.005

Abstract

Abstract:

Objective

To analyze the patterns of lymphatic metastasis and postoperative local recurrence in laryngeal squamous cell carcinoma (LSCC), with an aim to explore the delineation of clinical target volume for radiotherapy.

Methods

A total of 123 LSCC patients who had received surgical resection after first diagnosis or salvage surgery at Shandong Cancer Hospital between July 2012 and November 2018 were retrospectively analyzed. Lymph node metastasis was evaluated based on pathological findings. The patterns and potential factors for treatment failure were analyzed. The frequency and distribution of regional lymph nodal failure were recorded.

Results

The lymphatic metastasis rates at levels II, III, IV, and VI were 42.86%, 41.67%, 27.27%, and 25.00%, respectively. Lymph node metastasis at levels I, V, and VII were not found. The median follow-up time was 15 months, and the median time of progression-free survival was 16 months [95% confidence interval (CI): 8.9~23.1 months]. Thirty-one (35.23%) patients had local recurrence, 22 (25.00%) had regional lymph node metastasis, and 9 (10.23%) had distant metastasis. The frequency and distribution of regional lymph node failure were as follows: II 63.63%, III 36.36%, IV 18.18% and VI 13.63%. Univariate analysis demonstrated that lymph node dissection (χ²=25.87, P＜0.001) and prophylactic neck irradiation (PNI) (χ²=39.31, P＜0.05) was significantly correlated with lower regional nodal failure. Surgery (χ²=14.02, P=0.007) and postoperative radiotherapy (χ²=15.92, P＜0.001) was significantly correlated with local recurrence. Multivariate analysis using proportional hazards model revealed that failed PNI was an independent risk factor for regional lymph node metastasis (OR=1.385, 95%CI: 1.264~12.62, P=0.018).

Conclusion

The most frequently involved nodal levels were II and III, followed by IV and VI, whereas metastasis at levels I, V and VII were not found in our retrospective study. Local recurrence is the most common failure pattern, followed by regional lymph node metastasis. By means of PNI, the incidence of nodal failure can be reduced in LSCC patients.

Key words: Laryngeal carcinoma, Lymph node metastasis, Radiotherapy

Dongqing Wang, Juan Xu, Limin Zhai, Baosheng Li. Lymphatic metastasis and failure patterns in laryngeal squamous cell carcinoma after surgery[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(10): 773-778.

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Figures/Tables 5

References 16

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T/N分期	N₀	N₁	N_2a	N_2b	N_2c	N_x	合计
Tis	4	0	0	0	0	0	4
T₁	30	2	0	0	0	0	32
T₂	24	0	1	5	2	0	32
T₃	15	1	0	4	2	0	22
T_4a	8	2	0	4	4	0	18
T_4b	0	0	0	0	0	0	0
T_x	1	0	0	0	2	12	15
合计	82	5	1	13	10	12	123

T/N分期	N₀	N₁	N_2a	N_2b	N_2c	N_x	合计
Tis	4	0	0	0	0	0	4
T₁	30	2	0	0	0	0	32
T₂	24	0	1	5	2	0	32
T₃	15	1	0	4	2	0	22
T_4a	8	2	0	4	4	0	18
T_4b	0	0	0	0	0	0	0
T_x	1	0	0	0	2	12	15
合计	82	5	1	13	10	12	123

影响因素	淋巴结转移	χ²值	P值
手术方式		3.458	0.484
CO₂激光切除术（12例）	4（33.3）
喉裂开声带扩大切除术（22例）	4（18.2）
半喉切除术和（或）颈部淋巴结　清扫（51例）	10（19.6）
全喉切除术和（或）颈部淋巴结　清扫（29例）	3（10.3）
喉癌根治术，术式不确定（9例）	1（11.1）
是否行颈清扫术		25.87	＜0.001
颈部淋巴结清扫（80例）	4（5.0）
颈部淋巴结未清扫（43例）	18（41.8）
颈清扫是否存在转移		0.951	0.330
有转移（39例）	1（2.6）
无转移（41例）	3（7.3）
清扫淋巴结转移强度		0.473	0.492
转移1枚/1个区（23例）	3（13.0）
转移≥2枚/≥2个区（16例）	1（6.3）
是否颈部预防性照射		39.31	＜0.001
颈部预防照射（89例）	4（4.5）
颈部未预防照射（34例）	18（52.9）

影响因素	淋巴结转移	χ²值	P值
手术方式		3.458	0.484
CO₂激光切除术（12例）	4（33.3）
喉裂开声带扩大切除术（22例）	4（18.2）
半喉切除术和（或）颈部淋巴结　清扫（51例）	10（19.6）
全喉切除术和（或）颈部淋巴结　清扫（29例）	3（10.3）
喉癌根治术，术式不确定（9例）	1（11.1）
是否行颈清扫术		25.87	＜0.001
颈部淋巴结清扫（80例）	4（5.0）
颈部淋巴结未清扫（43例）	18（41.8）
颈清扫是否存在转移		0.951	0.330
有转移（39例）	1（2.6）
无转移（41例）	3（7.3）
清扫淋巴结转移强度		0.473	0.492
转移1枚/1个区（23例）	3（13.0）
转移≥2枚/≥2个区（16例）	1（6.3）
是否颈部预防性照射		39.31	＜0.001
颈部预防照射（89例）	4（4.5）
颈部未预防照射（34例）	18（52.9）

影响因素	局部复发	χ²值	P值
手术方式		14.02	0.007
CO₂激光切除术（12例）	8（66.7）
喉裂开声带扩大切除术（22例）	6（27.3）
半喉切除术和（或）颈部淋巴结　清扫（51例）	12（23.5）
全喉切除术和（或）颈部淋巴结　清扫（29例）	4（13.8）
喉癌根治术，术式不确定（9例）	1（11.1）
是否术后放射治疗		15.92	＜0.001
瘤床区放疗（80例）	11（13.8）
瘤床区未放疗（43例）	20（46.5）

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