口腔癌における旧N3症例 (UICC 1978年分類) の臨床的検討

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Head and neck cancers that have evidence of involvement of fixed regional lymph nodes metastasis had been defined as N3 by previous criteria of UICC in 1978. Thirty-nine patients of those N3 cases treated in our clinic from 1975 to 1986 were reviewed.<BR>The following characteristics of N3 cases were found by comparing N3 with NO-2 cases of the same period. The most frequent primary site of N3 case was lower alveolus and gingiva showing 36% of total cases. A high incidence was observed in T4 indicating 51.3% with increasing frequency with the progress of T classification. Most of the cases were squamous cell carcinoma. No significant relationships were observed in the male to female ratio, age distribution, macroscopic tumor types, mode of invasion of the primary tumor, and histological malignancy.<BR>Reclassification by new N criteria of UICC in 1987 of the previous N3 revealed that the most frequent cases was 12 cases (30.8%) in N2b and 3 cases (7.7%) in new N3. Regional tumor control of the neck area was obtained in 13 out of 39 treated cases, indicating 33. 3% of the control rate. A favorable regional control was obtained by surgery or surgery after irradiation of the cervical area. Surgery with total radical neck dissection with one side combined with upper neck dissection of contralateral side showed superior control to unilateral neck dissection. Five-year cummulative survival rate was 22.2% in total cases. No significant difference of survival rate was observed by generalized Wilcoxon analysis between subdivided groups in terms of primary treatment method, mode of neck dissection, and new N classification.<BR>Even in those cases of N3 whose fixed lymph nodal metastasis is clinically observed in only unilateral side of the neck, the possibility of occult lymph nodal metastasis at the contralateral side can be considered to be high. Then indication of bilateral neck dissection is discussed, and tentative criteria for the indication is proposed.<BR>Although new N3 eases such as larger than 6 cm with huge metastatic mass just adjacent to or enveloping the carotid artery are rare by incidence, active treatment including irradiation or chemotherapy may result in a reduction of the tumor enabling treatment by surgery, also indicating immediate reconstruction of resected cervical skin using cutaneous or myocutaneous flaps.

口腔癌における旧N3症例 (UICC 1978年分類) の臨床的検討

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