Objective: To investigate the incidence of occult cervical lymph node metastasis and the common neck level of metastases in cN0 laryngocarcinoma, and the relationship between the clinicopathologic features of laryngocarcinoma and cervical lymph node metastasis. Methods: A total of 506 cases with cN0 laryngocarcinoma treated at the First Affiliated Hospital of Chongqing Medical University between March 2011 and March 2018 were enrolled, and their medical records and follow-up data were retrospectively analyzed. Of them, 211 cases of were glottic carcinoma in stage T1 without neck dissection and they were observed by clinical follow-up; other 295 cases, including glottic carcinoma, supraglottic carcinoma and hypopharyngeal carcinoma in stage T2-T4 were treated with surgical resection of the primary lesions and selective neck dissection. SPSS 22.0 software was used to analyze the data. Results: The total incidence of cervical lymph node metastasis was 10.87%(55/506), with a lower incidence in T1 stage glottic carcinoma(6/211,2.84%) than that in other cases(49/295,16.61%). The incidence of cervical lymph node metastasis in glottic carcinoma (29/426, 6.81%) was lower than those in supraglottic carcinoma (22/71,30.99%) and subglottic carcinoma (4/9) (χ(2)=35.810,P<0.01).The pN+ rates of glottic carcinoma at T1, T2, T3 were 2.84%(6/211), 5.31%(6/113), 16.05%(13/81), and 19.05%(4/21), respectively (χ(2)=18.572, P<0.01). The pN+ rates of supraglottic carcinoma at T2, T3 and T4 were 3/13, 32.50%(13/40) and 6/13, respectively (χ(2)=3.649,P>0.05). The incidence of cervical lymph node metastasis in poorly differentiated carcinoma (17/42, 40.48%) was higher than those 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, respectively 43(50.59%) in level Ⅱa, 30(35.29%) in level Ⅲ, 1(1.18%) in level Ⅳ and 11(12.94%) in level Ⅵ. Conclusions: The occult cervical lymph node metastasis was frequently found in cN0 laryngocarcinoma. Selective neck dissection should be performed with surgery for the primary lesions in T3-T4 glottic laryngeal cancer, T2-T4 supraglottic laryngeal cancer and subglottic carcinoma, and the neck dissection for level Ⅱa and Ⅲ is appropriate. It is required to detect pre-laryngeal and pre-tracheal lymph nodes in patients with subglottic laryngeal carcinoma.
目的： 分析cN0喉癌颈部淋巴结隐匿性转移规律，以及与临床病理特征的关系，进一步探讨择区性颈淋巴清扫的范围。 方法： 对2011年3月至2018年3月重庆医科大学附属第一医院的506例cN0喉鳞状细胞癌患者的病历及随访资料进行回顾性分析。其中，T1声门型喉癌211例，原发灶行手术处理，颈部采取随访观察法。其他喉癌（包括≥T2的声门型喉癌，声门上型喉癌和声门下型喉癌）295例，原发灶行手术切除，颈部行择区性淋巴清扫术。以SPSS 22.0软件对数据进行统计学分析。 结果： T1声门型喉癌病理淋巴结阳性（pathologically positive，pN+）6例（2.84%），其他喉癌pN+49例（16.61%），总的pN+率为10.87%（55/506）。不同分型的喉癌中，pN+率分别为声门型6.81%（29/426）、声门上型30.99%（22/71）、声门下型比例为4/9，差异有统计学意义（χ(2)=35.810，P<0.01）。声门型喉癌中pN+率分别为T1 2.84%（6/211），T2 5.31%（6/113），T3 16.05%（13/81），T4 19.05%（4/21），差异有统计学意义（χ(2)=18.572，P<0.01）。声门上型喉癌pN+率分别为T2 3/13，T3 32.50%（13/40），T4 6/13（χ(2)=3.649，P>0.05）。不同病理分化程度的喉癌中，pN+率分别为低分化癌40.48%（17/42），中分化癌12.68%（26/205），高分化癌4.88%（12/246），差异有统计学意义（χ(2)=36.356，P<0.01）。择区性颈淋巴清扫术共获pN+淋巴结85枚，其中，Ⅱa区43枚（43/85，50.59%），Ⅲ区30枚（30/85，35.29%），Ⅳ区1枚（1/85，1.18%），Ⅵ区11枚（11/85，12.94%），包括喉前淋巴结10枚、气管前淋巴结1枚。 结论： cN0喉癌存在颈部淋巴结隐匿性转移，≥T3声门型喉癌、≥T2声门上型喉癌和声门下型喉癌宜在处理原发灶的同时，行择区性颈淋巴清扫。Ⅱa和Ⅲ区择区性颈淋巴清扫是恰当的。对于声门下有病变以及前连合受累的喉癌，探查喉前淋巴结、气管前淋巴结具有临床意义。.
Keywords: Laryngeal neoplasms; Lymphatic metastasis; Prognosis.