The clinicopathological study on cases of squamous cell carcinoma on oral region with secondary cervical lymph node metastasis

A clinical study was performed on 17 cases of squamous cell carcinoma of oral region with secondary cervical lymph node metastases (secondary metastases) who were treated in our department from January 1984 to December 2002. The results were as follows ; 1) Secondary metastases were found in 13.1% of NO cases. 2) The secondary metastases were clinically detected at 5 months on an average after primary treatments. In 64.7% of all cases, secondary metastases were found within 6 months. 3) Clinically and pathologically, there are no characteristic factors (primary site, T classification, degree of differentiation, mode of invasion and therapy) in cases with secondary metastases. 4) Extra-nodal spread was observed in 15 cases (88.2%). 5) The control rate of secondary metastases was 82.4%, cause specific 5-year cumulative survival rate was 64.2%, respectively. According to the follow-up after primary treatment of NO cases, it is important to detect cervical lymph nodes carefully with use of CT and/or US constantly and to perform therapeutic neck dissection as soon as possible if secondary metastases are detected.1984年1月から2002年12月に、当科で治療を行い、原発巣の再発がないにも関わらず、頚部リンパ節に転移(後発転移)を生じた口腔領域扁平上皮癌17例について、臨床病理学的に検討した｡ 1)NO症例の13.1%に後発転移を認めた｡ 2)後発転移の発現時期は、一次治療後平均5か月であった。また、64.7%の症例では、 6か月以内に認められた。 3)後発転移の予測因子として、原発部位、T分類、組織学的分化度、浸潤様式、一次治療について検討したが、特徴的な所見は認められなかった｡4)15例(88.2%)が節外浸潤を伴うリンパ節転移を有した｡5)頚部制御率は82.4%、累積生存率(cause specific)は3年で70.6%、5年で64.2％であり、初診時転移症例より良好であった。現時点での後発転移の予測は困難であり、NO症例の術後経過観察にあたっては、定期的にCT、USを用いた注意深い診察を行い、転移判明後は迅速な相応のできる体制づくりが肝要と思われた