이하선암종에서 경부 림프절 전이가 예후에 미치는 영향 및 전이의 위험인자에 관한 고찰

Abstract

Background and Objectives：Management of the clinicaly negative neck remains a controvertial issue in patients with carci-noma of the parotid gland. In order to asist in selecting appropriate patients of elective neck dissection, we sought to determine how regional nodal metastasis afects survival in patients with parotid carcinomas and to identify clinical predictors for nodal disease. Materials and Method：tive treatment at the Severance hospital between 1988 and 2003. A total of 84 neck dissections (ND) were performed. 24 of 84 patients who underwent neck dissection had pN(+) -staged stage. Seventy patients had an elective ND (subdigastric ND in 50 and supraomohyoid ND in 20), usually because of ominous histology or high T stage. Kaplan-Meier survival analysis was con-ducted to compare patients with and without histopathologic evidence of nodal disease. Univariate and multivariate analyses were caried out using logistic regresion evaluating the significance of demographic, clinical, and pathological data. Results：(p<0.00001). The following variables were significantly asociated to the risk of lymph node metastasis by univariate analy-sis：sex (p= 0.0093), facial palsy (p= 0.0001), T stage (p= 0.0003), tumor location (p= 0.01) and histologic type (p= 0.0009). By multivariate analysis, only facial palsy had the highest corelation with lymph node metastasis. ：Nodal disease significantly decrease survival in patients with parotid carcinoma. Tumor histopathologic type and facial nerve involvement are the most important predictors of nodal disease. Therefore, even in cN0, we should consider elective neck dissection in parotid carcinomas in case of high-grade malignancy and/or facial nerve paralysis. (Korean J Otolaryngol 2003 ;46 :856-61)