Cervical Lymph Node Metastasis-related Factors In Cn₀ Lingual Cancer And Its Surgical Treatment

Objective:Through the retrospective analysis of clinical data on cN0 lingual cancer (clinically negative) patients,discuss the rule and related factors of occult lymphatic metastasis, and the impact of different neck dissections on lingual cancer prognosis.Provide the theoretical basis for the choice of the suitable neck dissections in the cNo lingual cancer patients.Methods:Collect the data of total 87 cases of previously untreated cN0 lingual cancer patients which were initially hospitalized in the Department of Head and Neck Surgery, Affiliated Tumor Hospital of GuangXi Medical University, from January 2002 to August 2010, and all of them had no chemotherapy nor radiotherapy preoperatively. Analyze the correlation between occult cervical lymph node metastasis and the sex, age, preoperative disease duration, depth of primary focus invasion, T stages, pathological grades, prognostic factors of cN0 lingual cancer patients, the distribution of occult lymphatic metastasis and the impact of different neck dissections on the shoulder functions.Results:1.Single factor statistical analysis showed that the effect of age, sex, preoperative disease duration on cN0 lingual cancer patients with occult lymphatic metastasis had no significant difference statistically (P>0.05),but the effect of depth of primary focus invasion,T stages, pathological grades on cNo lingual cancer patients with occult lymphatic metastasis was significantly different statistically (P<0.05).2.Multivariate Cox proportional hazard model indicated that the T stages are the only independent prognostic factor of cN0 lingual cancer patients. Age and lymph node metastasis may be the prognostic factors in lingual cancer. But the impact of different neck dissections on prognosis had no statistically significant difference.3.The postoperative incidence of shoulder discomfort by modified radical neck dissection and elective neck dissection was 39.5% and 18.4% respectively.There was significant difference, i.e. there was less effect on the shoulders when choosing the elective neck dissection (X2=4.773, P<0.05).4.In 87 cases of cN0lingual cancer patients,20 cases were occult lymphatic metastasis and the metastatic rate was 23.0%.The frequency of which appear occult lymphatic metastasis was Level 120%(4/20), Levelâ…¡65%(13/20), Levelâ…¢45%(9/20), Levelâ…£10%(2/20) respectively.There was no skip lymph node metastasis in Levelâ…£, and also no metastasis in Levelâ…¤.Conclusions:1.The depth of primary focus invasion,T stages and pathological grades are related to the occult lymphatic metastasis of cN0 lingual cancer patients and these could be used as the predictive index in cN0 lingual cancer patients with occult cervical lymph node metastasis.2.The cN0 lingual cancer has a high occult cervical lymph node metastasis to the ipsilateral side and the in Levelâ… ,â…¡,â…¢is the most common. Elective neck dissection is advocated.