Objective: To analyze the incidence and the related risk factors of retropharyngeal lymph node metastasis in patients with hypopharyngeal squamous cell carcinoma, evaluate the accuracy of preoperative enhanced CT in judging retropharyngeal lymph node metastasis, and investigate the impact of retropharyngeal lymph node metastasis on the prognosis. Methods: Retrospective analyses were made on 398 patients with hypopharyngeal squamous cell carcinoma who underwent surgery as the primary therapy and accepted retropharyngeal lymph node exploration and clearance during surgery in Shandong Provincial ENT Hospital from January 2014 to December 2019. Multivariate logistic regression analysis was used to clarify the related risk factors of retropharyngeal lymph node metastasis. Multivariate Cox regression analysis was used to investigate the impact of retropharyngeal lymph node metastasis on prognosis. The retropharyngeal lymph nodes of 218 cases with available preoperative enhanced CT images were evaluated by two experienced radiologists and compared with postoperative pathological results. Results: Retropharyngeal lymph node metastasis were confirmed in 54 of 398 (13.6%) cases according to postoperative pathology. The sensitivity and specificity of preoperative enhanced CT in the diagnosis of retropharyngeal lymph node metastasis were 34.6% and 91.1%, respectively, and the overall accuracy was 84.4%. Multivariate logistic regression analysis showed that the site of the primary lesion and pathological N stage were independent risk factors for retropharyngeal lymph node metastasis in hypopharyngeal squamous cell carcinoma. Patients with primary lesion located in the posterior wall of hypopharynx (OR=4.83, 95% CI: 1.27-18.40), N2 stage (OR=6.30, 95% CI: 2.25-17.67), and N3 stage (OR=26.89, 95% CI: 5.76-125.58) were prone to retropharyngeal lymph node metastasis. The 5-year overall survival rate of the 398 patients was 50.4%, and the 5-year disease-free survival rate was 48.3%. Multivariate Cox regression analysis showed that T stage, N stage, retropharyngeal lymph node metastasis, and radiotherapy were independent influencing factors for overall survival (T stage: HR=1.28, 95% CI: 1.06-1.54; N stage: HR=1.26, 95% CI: 1.14-1.40; retropharyngeal lymph node metastasis: HR=2.13, 95% CI: 1.47-3.08; radiotherapy: HR=0.54, 95% CI: 0.38-0.76) and disease-free survival of patients with hypopharyngeal squamous cell carcinoma (T stage: HR=1.26, 95% CI: 1.06-1.51; N stage: HR=1.25, 95% CI: 1.13-1.37; retropharyngeal lymph node metastasis: HR=2.24, 95% CI: 1.56-3.21; radiotherapy: HR=0.55, 95% CI: 0.40-0.77). Conclusions: Metastasis of retropharyngeal lymph nodes in hypopharyngeal squamous cell carcinoma is not rare. Enhanced CT is of low accuracy and limited value in diagnosing retropharyngeal lymph node metastasis. Primary lesions located in the posterior wall of the hypopharyngx, N2 stage, and N3 stage are independent high-risk factors for retropharyngeal lymph node metastasis. The prognosis of hypopharyngeal cancer patients with retropharyngeal lymph node metastasis is worse, and active surgical exploration and clearance can effectively reduce the mortality caused by retropharyngeal lymph node metastasis.
目的： 探讨下咽鳞状细胞癌(简称鳞癌)咽后淋巴结转移的发生情况及影响因素，评估术前增强CT对下咽鳞癌咽后淋巴结转移的诊断效能及咽后淋巴结转移对下咽鳞癌患者预后的影响。 方法： 对2014年1月至2019年12月于山东省耳鼻喉医院头颈外科首选手术治疗并同期行咽后淋巴结探查、清除的原发下咽鳞癌患者398例进行回顾性分析，采用多因素logistic回归分析明确咽后淋巴结转移的影响因素，采用多因素Cox回归分析明确咽后淋巴结转移与下咽鳞癌患者预后的关系。由2位高年资头颈影像诊断医师对术前增强CT资料完整的218例患者进行咽后淋巴结评估，并与术后病理结果进行比较分析。 结果： 398例患者中，54例(13.6%)术后病理证实咽后淋巴结转移。术前增强CT诊断咽后淋巴结转移的灵敏度为34.6%，特异度为91.1%，准确率为84.4%。多因素logistic回归分析显示，原发部位、病理N分期为下咽鳞癌咽后淋巴结转移的独立影响因素，原发于下咽后壁区(OR＝4.83，95% CI：1.27~18.40)、N2期(OR＝6.30，95% CI：2.25~17.67)、N3期(OR＝26.89，95% CI：5.76~125.58)下咽鳞癌患者易发生咽后淋巴结转移。398例下咽鳞癌患者的5年总生存率为50.4%，无病生存率为48.3%。多因素Cox回归分析显示，T分期、N分期、咽后淋巴结转移和放疗既是下咽鳞癌患者总生存时间的独立影响因素(T分期：HR＝1.28，95%CI：1.06~1.54；N分期：HR＝1.26，95%CI：1.14~1.40；咽后淋巴结转移：HR＝2.13，95%CI：1.47~3.08；放疗：HR＝0.54，95%CI：0.38~0.76)，也是下咽鳞癌患者无病生存时间的独立影响因素(T分期：HR＝1.26，95%CI：1.06~1.51；N分期：HR＝1.25，95%CI：1.13~1.37；咽后淋巴结转移：HR＝2.24，95%CI：1.56~3.21；放疗：HR＝0.55，95%CI：0.40~0.77)。 结论： 下咽鳞癌易发生咽后淋巴结转移，增强CT作为诊断咽后淋巴结转移的技术手段，准确率不高，价值有限。原发于下咽后壁区、病理N分期为N2期、N3期是下咽鳞癌患者发生咽后淋巴结转移的高危因素。咽后淋巴结转移的下咽癌患者预后更差，而通过主动的手术探查和清除，可以有效避免咽后淋巴结转移致死。.
Keywords: Computed tomography; Hypopharyngeal neoplasms; Prognosis; Retropharyngeal lymph node; Surgical treatment.