国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (3): 312-317.doi: 10.7518/gjkq.2021036

• 论著 • 上一篇    下一篇

磁共振成像测量的浸润深度与舌鳞状细胞癌患者颈部淋巴结转移的相关性研究

李明(),原振英,南欣荣()   

  1. 山西医科大学第一医院口腔科 太原 030001
  • 收稿日期:2020-08-12 修回日期:2021-01-22 出版日期:2021-05-01 发布日期:2021-05-14
  • 通讯作者: 南欣荣
  • 作者简介:李明,医师,硕士, Email： limingq248@163.com
  • 基金资助:
    山西省重点研发计划(201803D31094)

Correlation between the depth of invasion measured by magnetic resonance imaging and cervical lymph node metastasis in patients with tongue squamous cell carcinoma

Li Ming(),Yuan Zhenying,Nan Xinrong()   

  1. Dept. of Stomatology, The First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2020-08-12 Revised:2021-01-22 Online:2021-05-01 Published:2021-05-14
  • Contact: Xinrong Nan
  • Supported by:
    Key Research and Development Plan of Shanxi Province(201803D31094)

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摘要：

目的 分析磁共振成像（MRI）测量的浸润深度（DOI）与临床颈部淋巴结阴性即cN0期舌鳞状细胞癌患者颈部淋巴结转移的相关性,明确MRI 测量的DOI是否可作为cN0期舌鳞状细胞癌患者颈部淋巴结转移的独立预测因素。方法 经纳入和排除标准筛选后选取61名舌鳞状细胞癌的患者,分析纳入患者中MRI测量的肿瘤DOI及其他临床病理因素（年龄、肿瘤部位、肿瘤T分期、肿瘤分化程度、神经侵犯）与颈部淋巴结转移的关系。结果 61例患者中19例（31%）患者术后病理颈部淋巴结转移阳性（pN+）,42例（69%）患者颈部淋巴结转移阴性（pN0）。单因素Logistic回归表明,MRI测量的DOI、T分期及神经侵犯因素与舌鳞状细胞癌患者颈部淋巴结转移有相关性（P<0.05）。多因素Logistic回归表明,仅MRI测量的DOI与颈部淋巴结转移相关（P<0.05）。MRI测量的19例pN+患者DOI均值为（13.2±4.3）mm,42例pN0患者DOI均值为（9.1±4.5）mm,两者差异具有统计学意义（T=3.36,P=0.001）。受试者工作特性曲线（ROC）表明,预测cN0期舌鳞状细胞癌患者颈部淋巴结转移的MRI测量DOI截止值为5.1 mm。结论 MRI测量是预测cN0期舌鳞状细胞癌患者颈部淋巴结转移的独立因素;MRI测量的DOI大于5.1 mm时,cN0期舌鳞状细胞癌患者发生颈部淋巴结转移的风险增加。

关键词: 舌鳞状细胞癌, 浸润深度, 磁共振成像, 颈部淋巴结转移

Abstract:

Objective The correlation between the depth of invasion (DOI) measured by magnetic resonance imaging (MRI) and cervical lymph node metastasis of stage cN0 tongue squamous cell carcinoma was analysed to determine whether the DOI measured by MRI could be used as an independent predictor of cervical lymph node metastasis in stage cN0 tongue squamous cell carcinoma. Methods A total of 61 patients with tongue squamous cell carcinoma were selected after screening using inclusion and exclusion criteria. The relationships between the DOI and other clinicopathological factors (age, tumour site, tumour T stage, tumour differentiation and nerve invasion) and cervical lymph node metastasis measured by MRI in included patients. Results Amongst the 61 patients, 19 (31%) were positive for postoperative pathological cervical lymph node metastasis (pN+) and 42 (69%) were negative for cervical lymph node metastasis (pN0). Single logistic regression showed that the DOI, T stage and nerve invasion factors measured by MRI were correlated with cervical lymph node metastasis in tongue squamous cell carcinoma (P<0.05). Multivariate logistic regression showed that the DOI measured by MRI was correlated with cervical lymph node metastasis (P<0.05). The mean DOI of the 19 pN+ patients measured by MRI was (13.2±4.3) mm, whereas that of the 42 pN0 patients was (9.1±4.5) mm. The difference was statistically significant (T=3.36, P=0.001). The receiver operating characteristic curve showed that the cut-off MRI DOI was 5.1 mm for predicting cervical lymph node metastasis in stage cN0 tongue squamous cell carcinoma. Conclusion The DOI measured by MRI is an independent factor in predicting cervical lymph node metastasis in stage cN0 tongue squamous cell carcinoma. When the DOI measured by MRI was greater than 5.1 mm, the risk of cervical lymph node metastasis increased in stage cN0 tongue squamous cell carcinoma.

Key words: tongue squamous cell carcinoma, depth of invasion, magnetic resonance imaging, cervical lymph node metastasis

中图分类号: 

  • R782

图1

MRI测量舌鳞状细胞癌DOI示意图 A：MRI冠状位;B：MRI横断位。"

表 1

cN0期舌鳞状细胞癌患者颈部淋巴结转移的单因素Logistic回归"

因素 n 淋巴结阳性者 淋巴结阳性率/% P值
年龄/岁
>60 36 12 33 0.658
≤60 25 7 28
肿瘤部位
舌缘舌腹 51 15 29 0.376
舌背 10 4 40
T分期
T1 16 3 19 0.035
T2 27 7 26
T3 9 4 44
T4 9 5 56
DOI/mm
≤5 11 1 9 0.015
>5, ≤10 16 3 19
>10 34 15 44
肿瘤分化
高分化 36 11 31 0.509
中分化 17 4 24
低分化 8 4 50
神经侵犯
+ 12 7 58 0.023
- 49 12 24
脉管癌栓
+ 1 1 100
- 60 18 30

表 2

cN0期舌鳞状细胞癌患者颈部淋巴结转移的多因素Logistic回归"

因素 P值 OR值 OR值的95%CI
下限 上限
DOI/mm
≤5 0.027 0.028 0.001 0.661
>5, ≤10 0.042 0.184 0.036 0.939
>10 0.05
T分期
T1 0.211 5.221 0.393 69.387
T2 0.683 0.783 0.242 2.534
T3 0.839 0.892 0.294 2.702
T4 0.429
神经侵犯 0.137 0.467 0.171 1.274

表 3

MRI测量的DOI与颈部淋巴结转移的关系"

DOI/mm 总数量 pN0组 pN+组
数量 百分比/% 数量 百分比/%
≤5.1 12 11 92 1 8
>5.1 49 31 63 18 37
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