| Objective To analyze the incidence of occult cervical lymph node metastasis as well as the most common metastasis area in cN0laryngocarcinoma.Toobservetherelationshipbetweenthe clinicopathologic features of laryngocarcinoma and cervical lymph node metastasis.To explore the specific scope of selective neck dissection.Methods 506 cases of cN0 laryngocarcinoma patients were screened from March 2011 to March 2018 in the first affiliated hospital of Chongqing medical university,records and follow-up data were retrospectively analyzed.Among these samples,211 cases of laryngeal carcinoma were glottic carcinoma in stage T1 without cervical lymph node dissection and patients were observed by clinical follow-up.While other295 cases of laryngeal carcinoma(including glottic carcinoma,supraglottic carcinoma and hypopharyngeal carcinoma which were stage T2-T4)were treated with surgical resection of the primary lesions and selective neck dissection.Results The incidence of cervical lymph node metastasis in T1 stage glottic carcinoma(6/211,2.84%)was lower than the incidence in other laryngeal normal squamous cell carcinoma(49/295,16.61%),and the total incidence of cervical lymph node metastasis in laryngocarcinoma was10.87%(55/506).Meanwhile,the incidence of cervical lymph node metastasis in glottic carcinoma(29/426,6.81%)was lower than the one in supraglottic carcinoma(22/71,30.99%)and subglottic carcinoma(4/9,44.44%)(χ~2=35.810,P﹤0.01).The pN+rates of glottic carcinoma were T12.84%(6/211),T2 5.31%(6/113),T3 16.05%(13/81),T4 19.05%(4/21),respectively(χ~2=18.572,P﹤0.01).The pN+rates of supraglottic carcinoma were T2 23.08%(3/13),T3 32.50%(13/40)and T4 46.15%(6/13),respectively(χ~2=3.649,P﹥0.05).Besides,according to different pathological differentiation degrees,the incidence of cervical lymph node metastasis in poorly differentiated carcinoma(17/42,40.48%)was higher than the one in moderately differentiated carcinoma(26/205,12.68%)and high differentiated carcinoma(12/246,4.88%)(χ~2=36.356,P﹤0.01).Moreover,85 pN+lymph nodes were obtained by selective neck dissection,Ⅱa area,Ⅲarea,Ⅳarea andⅥarea contain 43(43/85,50.59%),30(30/85,35.29%),1(1/85,1.18%)and 11(11/85,12.94%)lymph nodes respectively.Conclusion The occult cervical lymph node metastasis was frequently found in cN0 laryngocarcinoma.Selective neck dissection should be performed while the primary lesions are treated in patients with T3-T4stage glottic laryngeal cancer,T2-T4 stage supraglottic laryngeal cancer and subglottic carcinoma,and theⅡa andⅢareas of cervical lymph node dissection is appropriate.It is of clinical significance to detect pre-laryngeal lymph nodes and pre-tracheal lymph nodes in patients with subglottic lesions and pre-associated involvement of laryngeal carcinoma. |
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