Objective: To analyze the characteristics of cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). Methods: A retrospective study was conducted. A total of 329 patients with TSCC who underwent en bloc resection of primary tumor and neck dissection in the Second Xiangya Hospital of Central South University from June 2010 to March 2018 were included. There were 283 males and 46 females, aged from 26 to 80 years. All patients underwent the modified neck dissection. The main difference between the modified neck dissection and the traditional neck dissection lay in the managements of unconventional lymph nodes. The lymphatic adipose tissues adjacent to the superior thyroid artery, the base of facial artery and the branches of external carotid artery were thoroughly dissected. The primary tumor as well as lingual artery, tissues along the lingual artery and lymph nodes in the mouth floor were resected. χ2 test was used for comparison of count data, and linear regression model was used for multivariate analysis. Results: Cervical lymph node metastases were found in 136 patients (41.3%). Among 142 patients (T1-2cN0) with supraomohyoid neck dissection, 22 patients had pathologically occult lymph node metastases (15.5%), with a 5-year overall survival rate of 90.2%, which was similar to the 5-year overall survival rate of 92.1% in 120 patients without lymph node metastasis (χ2=0.156, P=0.693). Multivariate linear regression analysis showed that T stage, clinical stage and unconventional lymph node metastasis were important factors for cervical lymph node metastasis in tongue cancer patients (P<0.05). Unconventional lymph node metastases occurred in 30 patients (9.1%), including the metastases of lymph nodes in the floor of mouth (3.0%), the lingual artery (2.4%), the base of the external maxillary artery (2.1%), the superior thyroid artery (0.9%), and the external carotid artery (0.6%). There were significant differences in the unconventional lymph node metastasis rates between patients with negative and positive conventional lymph node metastases [4.9%(10/203) vs. 15.9%(20/126), χ2=11.242, P=0.001] and also between patients with depth of invasion ≤5 mm, 5 mm <depth of invasion ≤10 mm or depth of invasion >10 mm [3.1%(2/64) vs. 5.7%(6/106) vs. 13.8%(22/159), χ2=7.907, P=0.005]. Conclusion: Supraomohyoid neck dissection can achieve reliable control efficacy in patients with cN0 tongue cancer. All patients with lymph node dissection should undergo unconventional lymph node dissection. Unconventional lymph node dissection is strongly recommended for patients with conventional lymph node metastasis.
目的： 分析舌鳞状细胞癌（简称鳞癌）颈部淋巴结转移的特点。 方法： 采用回顾性研究方法，纳入2010年6月至2018年3月间在中南大学湘雅二医院口腔颌面外科就诊，行原发灶及颈淋巴清扫（简称颈清）的连续整块切除手术的舌鳞癌患者329例，其中男性283例，女性46例，年龄26~80岁。均采用新颈清术式：与经典颈清的主要区别在于非常规淋巴结的处理，彻底清扫甲状腺上动脉、面动脉基部、颈外动脉各分支旁淋巴脂肪组织，将舌动脉及其沿线组织及口底淋巴结与原发灶一并切除。计数资料的比较采用χ2检验，多因素分析采用线性回归模型。 结果： 本研究共136例（41.3%）患者发生了颈淋巴结转移。142例T1-2cN0期患者行肩胛舌骨上清扫，其中22例（15.5%）存在隐匿性淋巴结转移，与其余120例无淋巴结转移者相比，5年总生存率差异无统计学意义（90.2%比92.1%，χ2=0.156，P=0.693）。多因素分析显示T分期、临床分期以及非常规淋巴结转移是舌鳞癌患者出现颈部淋巴结转移的影响因素（P值均<0.05）。共有30例患者发现非常规淋巴结转移，转移率为9.1%，其中口底淋巴结转移率为3.0%，舌动脉淋巴结转移率为2.4%，面动脉淋巴结转移率为2.1%，甲状腺上动脉淋巴结转移率为0.9%，颈外动脉淋巴结转移率为0.6%。对于非常规淋巴结转移率，常规淋巴结转移阴性组与常规淋巴结转移阳性组相比，差异有统计学意义［4.9%（10/203）比15.9%（20/126），χ2=11.242，P=0.001］；浸润深度（depth of invasion，DOI）≤5 mm组、5 mm<DOI≤10 mm组以及DOI>10 mm组的差异有统计学意义［3.1%（2/64）比5.7%（6/106）比13.8%（22/159），χ2=7.907，P=0.005］。 结论： cN0舌鳞癌患者选择肩胛舌骨上清扫可获得可靠的控制效果。建议对所有需颈清的患者行非常规淋巴清扫，强烈推荐对存在常规淋巴结转移的患者进行非常规淋巴清扫。.