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首页> 外文期刊>Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery >Extensive neck node metastases (N3) in head and neck squamous carcinoma: is radical treatment warranted?
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Extensive neck node metastases (N3) in head and neck squamous carcinoma: is radical treatment warranted?

机译：头颈部鳞癌中广泛的颈部淋巴结转移（N3）：是否需要进行根治性治疗？

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OBJECTIVE: Head and neck squamous cell carcinoma (HNSCC) patients with N3 neck disease at presentation are the minority. Prognosis for such patients is poor, but there is disagreement about which treatment policy is best adopted. The aim of this study was to identify which groups of patients are best offered radical treatment, examining factors of association, prognosis, and survival. STUDY DESIGN: Prospective cohort study. SETTING: Regional tertiary head and neck cancer unit. SUBJECTS AND METHODS: Data were collected prospectively from patients treated for HNSCC with N3 nodal disease between 1975 and 2005. The data collected included age, sex, tumor TNM stage, histological grade, treatment, and survival. Odds ratio was used to calculate whether each parameter was statistically significant. Tumor-specific and observed survival curves were also calculated. RESULTS: A total of 275 patients had N3 disease. Multivariate analysis confirmed that advanced disease at the primary site (odds ratio = 4.6, P = .0261) mitigated against curative treatment. Comparison of tumor-specific survival between curative and palliative treatment strategies suggests that aggressive treatment is associated with greatly improved survival (median survival = 1.45 years, 95% confidence interval [CI] = 1.23-1.67 years; 5-year survival = 26.6%, CI = 17.14%-36.06%) compared with those treated palliatively (median survival = 3.18 months, CI = 3.06-3.30 months; no 5-year survivors; P < .0001). CONCLUSION: A major factor in determining treatment strategies for N3 disease HNSCC is the extent of disease at the primary site. These data suggest that aggressive treatment of the neck improves survival and should be considered in these patients.
机译：目的：头颈部鳞状细胞癌（HNSCC）患有N3颈部疾病的患者为少数。这类患者的预后较差，但对于哪种治疗策略最佳则存在分歧。这项研究的目的是确定哪些患者组最适合接受根治性治疗，检查相关因素，预后和生存率。研究设计：前瞻性队列研究。地点：地区三级头颈癌科。研究对象和方法：前瞻性收集1975年至2005年间接受过N3淋巴结转移的HNSCC患者的数据。收集的数据包括年龄，性别，肿瘤TNM分期，组织学分级，治疗和生存期。赔率用于计算每个参数是否具有统计学意义。还计算了肿瘤特异性和观察到的生存曲线。结果：总共275例患者患有N3疾病。多因素分析证实，原发性晚期疾病（优势比= 4.6，P = .0261）可减轻对治愈性疾病的治疗。治愈性和姑息治疗策略之间的肿瘤特异性生存率比较表明，积极治疗与生存率大大提高有关（中位生存期= 1.45年，95％置信区间[CI] = 1.23-1.67年; 5年生存期= 26.6％， CI = 17.14％-36.06％），而姑息治疗者（中位生存期= 3.18个月，CI = 3.06-3.30个月;无5年生存期; P <.0001）。结论：决定N3型HNSCC治疗策略的主要因素是原发部位的疾病范围。这些数据表明，积极治疗颈部可改善生存率，因此应在这些患者中考虑。

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