纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌颈淋巴清扫术中的应用
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摘要
目的探讨纳米炭淋巴结示踪剂在c N0舌鳞状细胞癌患者颈淋巴清扫术中的应用价值。方法选取96例c N0舌鳞状细胞癌患者作为研究对象,随机分为纳米炭组(试验组,50例)和对照组(46例),其中纳米炭组患者于术前12 h在距离肿块边缘0.5 cm处黏膜下多点注射纳米炭混悬注射液(每个注射点0.1 m L,共计3~4个注射点)。根据原发肿瘤的大小及部位选择行肩胛舌骨肌上(Ⅰ~Ⅲ区)或全颈(Ⅰ~Ⅴ区)淋巴清扫术。标本离体后解剖、分离所有淋巴结,并行病理学检查,记录检获的淋巴结数目、大小、部位、病理结果。将试验组与对照组所得数据进行比较,采用SPSS 19.0统计软件包进行统计学分析。结果 31例患者行肩胛舌骨肌上颈淋巴清扫术,共检出淋巴结1 137枚,纳米炭组平均每例检出淋巴结数(43.79±19.23)枚,显著高于对照组的(30.82±8.77)枚(P=0.019),两组均以Ⅲ区检出的淋巴结数最多,但纳米炭组Ⅱ区检出的淋巴结数及构成比均显著高于对照组(P=0.000)。65例全颈淋巴清扫术共检出淋巴结3 938枚,纳米炭组平均每例检出淋巴结数为(66.67±20.02)枚,对照组为(53.03±20.98)枚,两组差异有统计学意义(P=0.026),两组在各区(Ⅰ~Ⅴ区)检出淋巴结数的构成比的差异无统计学意义(P=0.354)。两种颈淋巴清扫术式中,纳米炭组检出微小淋巴结的比例和检获淋巴结的准确率均高于对照组(P=0.000);纳米炭组中染色淋巴结癌转移的检出率高于未染色的淋巴结(P=0.000)。结论纳米炭淋巴结示踪剂可以显著提高c N0舌鳞状细胞癌患者颈淋巴清扫术中淋巴结特别是微小淋巴结的检出率,有助于提高颈淋巴清扫术的彻底性和患者临床病理分期的准确性。
Objective This study aimed to investigate the value of carbon nanoparticles as lymph node tracers in neck dissection for c N0 lingual squamous cell carcinoma patients. Methods Ninety-six patients with c N0 lingual squamous cell carcinoma were recruited to undergo surgical treatment were randomly divided into two groups, namely, the carbon nanoparticlelabeled group(the experimental group, 50 cases) and the control group(46 cases). Carbon nanoparticle suspension was injected into the submucosal layer around the site of the primary tumor at three or four points(0.1 m L for each point) 12 h before surgery. Supraomohyoid neck dissection(SOHND, Levels Ⅰ to Ⅲ) or comprehensive neck dissection(CND, Levels Ⅰto Ⅴ) were performed based on the size and location of the primary tumor. All the lymph nodes were dissected and separated from the ex vivo surgical specimens for histopathological evaluation. The number, size, location, and pathological result of all the lymph nodes were compared between the two groups. Statistical analyses were conducted by SPSS 19.0 software. Results A total of 1 137 lymph nodes were detected in 31 SOHND patients. The average number of lymph nodes detected in the experimental group was(43.79±19.23) /case, which was significantly higher than that in the control group [(30.82±8.77) /case](P=0.019). Level Ⅲ covered the largest number of lymph nodes in the two groups. However, the number and proportion of lymph nodes found in Level Ⅱ of the experimental group were significantly higher than those of the control group(P=0.000). A total of 3 938 lymph nodes were detected in 65 CND patients. The average number of lymph nodes detected in the experimental group [(66.67±20.02) /case] was larger than that in the control group [(53.03±20.98) /case](P=0.026). The difference in the lymph node location between the two groups was not statistically significant(P=0.354). In the two neck dissection methods, both the proportion of minute lymph nodes and the accuracy of the detected lymph nodes in the experimental group were significantly larger than those in the control groups(P=0.000). Compared with the control group, more metastases were proven by the carbon nanoparticlelabeled lymph nodes(P=0.000) in the experimental group. Conclusion Carbon nanoparticles as lymph node tracers in patients with c N0 lingual squamous cell carcinoma undergoing neck dissection can increase the number of detected lymph nodes, especially the minute nodes. Such nanoparticles can further ensure the thoroughness of neck dissection and the accuracy of clinicopathological stage.
Objective This study aimed to investigate the value of carbon nanoparticles as lymph node tracers in neck dissection for c N0 lingual squamous cell carcinoma patients. Methods Ninety-six patients with c N0 lingual squamous cell carcinoma were recruited to undergo surgical treatment were randomly divided into two groups, namely, the carbon nanoparticlelabeled group(the experimental group, 50 cases) and the control group(46 cases). Carbon nanoparticle suspension was injected into the submucosal layer around the site of the primary tumor at three or four points(0.1 m L for each point) 12 h before surgery. Supraomohyoid neck dissection(SOHND, Levels Ⅰ to Ⅲ) or comprehensive neck dissection(CND, Levels Ⅰto Ⅴ) were performed based on the size and location of the primary tumor. All the lymph nodes were dissected and separated from the ex vivo surgical specimens for histopathological evaluation. The number, size, location, and pathological result of all the lymph nodes were compared between the two groups. Statistical analyses were conducted by SPSS 19.0 software. Results A total of 1 137 lymph nodes were detected in 31 SOHND patients. The average number of lymph nodes detected in the experimental group was(43.79±19.23) /case, which was significantly higher than that in the control group [(30.82±8.77) /case](P=0.019). Level Ⅲ covered the largest number of lymph nodes in the two groups. However, the number and proportion of lymph nodes found in Level Ⅱ of the experimental group were significantly higher than those of the control group(P=0.000). A total of 3 938 lymph nodes were detected in 65 CND patients. The average number of lymph nodes detected in the experimental group [(66.67±20.02) /case] was larger than that in the control group [(53.03±20.98) /case](P=0.026). The difference in the lymph node location between the two groups was not statistically significant(P=0.354). In the two neck dissection methods, both the proportion of minute lymph nodes and the accuracy of the detected lymph nodes in the experimental group were significantly larger than those in the control groups(P=0.000). Compared with the control group, more metastases were proven by the carbon nanoparticlelabeled lymph nodes(P=0.000) in the experimental group. Conclusion Carbon nanoparticles as lymph node tracers in patients with c N0 lingual squamous cell carcinoma undergoing neck dissection can increase the number of detected lymph nodes, especially the minute nodes. Such nanoparticles can further ensure the thoroughness of neck dissection and the accuracy of clinicopathological stage.
引文
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[15]Hao RT,Chen J,Zhao LH,et al.Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma[J].Eur J Surg Oncol,2012,38(8):718-724.
[16]Li Y,Jian WH,Guo ZM,et al.A meta-analysis of carbon nanoparticles for identifying lymph nodes and protecting parathyroid glands during surgery[J].Otolaryngol Head Neck Surg,2015,152(6):1007-1016.
[17]Cai HK,He HF,Tian W,et al.Colorectal cancer lymph node staining by activated carbon nanoparticles suspension in vivo or methylene blue in vitro[J].World J Gastroenterol,2012,18(42):6148-6154.
[18]Yan J,Zheng X,Liu Z,et al.A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer[J].Surg Endosc,2016,30(4):1294-1300.
[19]Jiang Y,Lin N,Huang S,et al.Tracking nonpalpable breast cancer for breast-conserving surgery with carbon nanoparticles:implication in tumor location and lymph node dissection[J].Medicine:Baltimore,2015,94(10):e605.
[20]Wu X,Lin Q,Chen G,et al.Sentinel lymph node detection using carbon nanoparticles in patients with early breast cancer[J].PLo S ONE,2015,10(8):e0135714.
[21]关丽梅,高琼,赵德安,等.纳米炭混悬注射液在颈淋巴结清扫术中应用[J].延安大学学报(医学科学版),2008,6(4):106-107.Guan LM,Gao Q,Zhao DA,et al.The application of carbon nanoparticles suspension injection in neck dissection[J].J Yanan Univ(Med Sci Ed),2008,6(4):106-107.
[2]Weinberg J,Greaney EM.Identifi cation of regional lymph nodes by means of a vital staining dye during surgery of gastric cancer[J].Surg Gynecol Obstet,1950,90(5):561-567.
[3]郑家伟,李金忠,涂文勇,等.口腔颌面部恶性肿瘤治疗指南[J].中国口腔颌面外科杂志,2010,8(2):98-106.Zheng JW,Li JZ,Tu WY,et al.Treatment guidelines of oral and maxillofacial malignant tumor[J].Chin J Oral Maxillofac Surg,2010,8(2):98-106.
[4]Iqbal H,Bhatti AB,Hussain R,et al.Regional failures after selective neck dissection in previously untreated squamous cell carcinoma of oral cavity[J].Int J Surg Oncol,2014:205715.
[5]李思毅,胡永杰,张陈平,等.c N0早期舌体鳞癌的颈部处理探讨[J].华西口腔医学杂志,2011,29(6):596-599.Li SY,Hu YJ,Zhang CP,et al.Study on neck management for tongue squamous cell carcinoma of c N0 stage[J].West Chin J Stomatol,2011,29(6):596-599.
[6]Sun SP,Zhang Y,Cui ZQ,et al.Clinical application of carbon nanoparticle lymph node tracer in theⅥregion lymph node dissection of differentiated thyroid cancer[J].Genet Mol Res,2014,13(2):3432-3437.
[7]Tausch C,Baege A,Rageth C.Mapping lymph nodes in cancer management—role of 99m Tc-tilmanocept injection[J].Onco Targets Ther,2014,7:1151-1158.
[8]van der Vorst JR,Vahrmeijer AL,Hutteman M,et al.Nearinfrared fl uorescence imaging of a solitary fi brous tumor of the pancreas using methylene blue[J].World J Gastrointest Surg,2012,4(7):180-184.
[9]Buda A,Di Martino G,Vecchione F,et al.Optimizing strategies for sentinel lymph node mapping in early-stage cervical and endometrial cancer:comparison of real-time fl uorescence with indocyanine green and methylene blue[J].Int J Gynecol Cancer,2015,25(8):1513-1518.
[10]van den Berg NS,Brouwer OR,Klop WM,et al.Concomitant radio-and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99m Tc-nanocolloid[J].Eur J Nucl Med Mol Imaging,2012,39(7):1128-1136.
[11]Kraft JC,Ho RJ.Interactions of indocyanine green and lipid in enhancing near-infrared fl uorescence properties:the basis for near-infrared imaging in vivo[J].Biochemistry,2014,53(8):1275-1283.
[12]Sondak VK,King DW,Zager JS,et al.Combined analysis of phaseⅢtrials evaluating 99mTc tilmanocept and vital blue dye for identifi cation of sentinel lymph nodes in clinically node-negative cutaneous melanoma[J].Ann Surg Oncol,2013,20(2):680-688.
[13]Hagiwara A,Takahashi T,Sawai K,et al.Selective drug delivery to peri-tumoral region and regional lymphatics by local injection of aclarubicin adsorbed on activated carbon particles in patients with breast cancer—a pilot study[J].Anticancer Drugs,1997,8(7):666-670.
[14]张润,王思洋,汪晓东,等.纳米碳的临床应用研究进展[J].肿瘤学杂志,2012,18(11):865-869.Zhang R,Wang SY,Wang XD,et al.Research progress of carbon nanoparticles in clinical application[J].J Chin Oncol,2012,18(11):865-869.
[15]Hao RT,Chen J,Zhao LH,et al.Sentinel lymph node biopsy using carbon nanoparticles for Chinese patients with papillary thyroid microcarcinoma[J].Eur J Surg Oncol,2012,38(8):718-724.
[16]Li Y,Jian WH,Guo ZM,et al.A meta-analysis of carbon nanoparticles for identifying lymph nodes and protecting parathyroid glands during surgery[J].Otolaryngol Head Neck Surg,2015,152(6):1007-1016.
[17]Cai HK,He HF,Tian W,et al.Colorectal cancer lymph node staining by activated carbon nanoparticles suspension in vivo or methylene blue in vitro[J].World J Gastroenterol,2012,18(42):6148-6154.
[18]Yan J,Zheng X,Liu Z,et al.A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer[J].Surg Endosc,2016,30(4):1294-1300.
[19]Jiang Y,Lin N,Huang S,et al.Tracking nonpalpable breast cancer for breast-conserving surgery with carbon nanoparticles:implication in tumor location and lymph node dissection[J].Medicine:Baltimore,2015,94(10):e605.
[20]Wu X,Lin Q,Chen G,et al.Sentinel lymph node detection using carbon nanoparticles in patients with early breast cancer[J].PLo S ONE,2015,10(8):e0135714.
[21]关丽梅,高琼,赵德安,等.纳米炭混悬注射液在颈淋巴结清扫术中应用[J].延安大学学报(医学科学版),2008,6(4):106-107.Guan LM,Gao Q,Zhao DA,et al.The application of carbon nanoparticles suspension injection in neck dissection[J].J Yanan Univ(Med Sci Ed),2008,6(4):106-107.