KHẢO SÁT TƯƠNG QUAN GIỮA ĐỘ SÂU XÂM NHẬP TRÊN GIẢI PHẪU BỆNH VÀ DI CĂN HẠCH CỔ CỦA UNG THƯ XOANG LÊ

Abstract

Background: Hypopharyngeal carcinoma is a rare malignancy, with approximately 85,000 new cases and over 38,000 deaths globally, accounting for roughly 0.4% of total cancer incidence and mortality [1]. Notably, pyriform sinus carcinoma accounts for 80% of hypopharyngeal cancers [2]. The prognosis for pyriform sinus carcinoma is relatively poor, as it is frequently diagnosed at an advanced stage. Generally, lymph node metastasis responds less favorably to treatment compared to the primary tumor. Furthermore, cervical lymph node metastasis is considered a potent prognostic factor; it is associated with a higher risk of regional recurrence and distant metastasis, while significantly reducing survival rates in patients with pyriform sinus carcinoma [3]. Primary tumor resection combined with neck dissection remains the mainstay of treatment for patients with clinically positive cervical lymph nodes. However, the management of patients with no clinical evidence of cervical lymph node metastasis remains controversial [4] due to the frequent detection of occult metastasis. Identifying objective prognostic factors for cervical lymph node metastasis is crucial for facilitating better personalized treatment decisions. Objectives: To evaluate the association between pathological depth of invasion and cervical lymph node metastasis in pyriform sinus cancer. Materials and Methods: A descriptive study was conducted on a case series of 31 patients with pyriform sinus cancer at Cho Ray Hospital from 2024 to 2025. Data were collected from medical records, imaging studies (CT/MRI), and post-operative histopathological reports. Statistical analysis was performed using SPSS software. Results: Thirty-one patients with PSC met the inclusion criteria. All patients (100%) were male, with a mean age of 61.4 years. The rate of pathologically confirmed cervical lymph node metastasis was 80.6%. The rate of occult metastasis was 40%. Bilateral cervical node metastasis accounted for 32% of all metastatic cases. The mean Depth of Invasion (DOI) in the node-positive group was 16,57 ± 5,2 mm, which was significantly higher than in the node-negative group ( 7,3 ± 2,3 mm) (p < 0,05). The optimal DOI cut off value for predicting cervical lymph node metastasis was 10,5 mm (sensitivity: 85.7%, specificity: 100%). Conclusion: Pyriform sinus cancer is commonly detected at an advanced stage and has a very high rate of cervical lymph node metastasis. Depth of Invasion (DOI) and T stage are strong predictors of cervical lymph node metastatic status. Cases with a depth of invasion ≥10.5 mm should be considered for cervical lymph node dissection.