[総説］口腔癌の潜在性頚部リンパ節転移に関する諸問題
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概要
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Patients with clinically negative cervical lymph nodes (NO) are believed to have a good prognosis; however, prognosis is poor for patients with lymph node metastasis occurring after excision or radiotherapy of the primary tumor. Over the past decades, the major concern in the management of oral squamous cell carcinoma patients with neck NO is whether elective prophylactic lymph node dissection should be performed or not. Central to this debate is the ability to identify high-risk patient and to determine if there is a therapeutic advantage of treating occult cervical lymph node metastasis. Recently, there is increasing evidence that imaging techniques, especially combined with fine-needle aspiration cytology, are considerably better than palpation for the assessment of the status of the lymph nodes in the neck. In the authors' view, the capsulized metastatic nodes should not be destroyed because it is possible that the metastatic cells having highly malignant characteristics in its early stages can easily disseminate the cancer cells. If a convenient diagnostic indicator such as clinical and microscopic features suggesting the presence of occult positive nodes in patients with neck NO could be obtained reliably at the time of incisional or excisional biopsy, it would permit an expanded classification. In addition, to allow for comparison between treatment modalities, such an indicator could ultimately allow for changes in treatment decisions or aid clinicians in deciding whether there is a need for close follow up based on the relationship between this indicator and patient outcome. In the present paper, the authors described data concerning the probability of occult nodal involvement in the neck NO, and a rationale for treatment modalities is reviewed.
- 琉球医学会,Ryukyu Medical Associationの論文
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