Risk Analysis,Diagnosis And Treatment Of Cervical Lymph Node Metastasis In CN+ Laryngeal Squamous Cell Carcinoma

Purpose: To analyze the clinical,pathological characteristics and metastasis of cN + laryngeal carcinoma,and to explore its diagnosis and treatment.Methods: Followed up 1030 cases of laryngeal squamous cell carcinoma treated by surgery in the Department of Otorhinolaryngology,the first affiliated Hospital of Chongqing Medical University from March2011 to January 2021.83 cases(83/1030 cN+ cases)were included for retrospective analysis of clinical data and follow-up data.Results : The false positive rate for cN+ was 21.7%,which was associated with classification and staging.Based on differing standards of imaging,false positive of lymph nodes and the diagnosis of extranodal extension(ENE)is different.A total of 255 metastatic lymph nodes were obtained during the operation,92.2% of the lymph nodes were in II and III levels,5.5% were in IV level.Based on Kaplan-Meier and log-rank tests,The 3-year cumulative neck control rates for selective neck dissection(SND)and non-SND were 91.3% and 77.8%,respectively.Among the 83 cases of cN+ laryngeal carcinoma,there were pN+65 cases and pN-18 cases after operation.The false positive rate of cN+ was 21.7%(18/83).CN+ cervical lymph node metastasis was related to classification and staging,and the difference was statistically significant(P < 0.05).The false positive rate of cN+ in different types of laryngeal carcinoma was 57.7%(16/27)in glottic type and 3.9%(2/55)in supraglottic type.With the increase of T stage,the false positive rate decreased.The false positive rates of different CT imaging features were as follows:(1)the critical lymph nodes of more than 2 sizes were 27.3%(3/11),the 1cm～3cm of lymph nodes was 29.4%(15/51),and the lymph nodes > 3cm were not false positive(0/21);(2).The enhancement types of uniform enhancement,inhomogeneous enhancement and circular enhancement were 34.3%(12/35),31.6 pm(6x19)and 0%(0/29)respectively.(5)the shape and boundary of lymph nodes were 0%(0/24).Conclusion: There is false positive in cN+ laryngeal carcinoma,which is related to tumor classification and staging.Preoperative imaging diagnosis of cN+ should not be over-dependent on size,but should be combined with the specific manifestations of lymph node metastasis such as circular enhancement and unclear boundaries.Proper use of SND in the treatment of cN+ laryngeal carcinoma is safe and effective,and reduces the risk of overtreatment.In patients with pN+ laryngeal carcinoma,postoperative supplementary treatment can improve the neck control rate and survival rate.However,even if postoperative treatment is performed in patients with ENE+,it is still an unfavorable factor affecting the prognosis.