口腔颌面部原发性恶性黑色素瘤治疗的回顾分析

目的：探索影响口腔颌面部原发性恶性黑色素瘤的预后因素,以期获得最佳的治疗模式。方法：回顾分析1970-2004我院收治的54例口腔恶黑的临床资料。结果：依照AJCC分类标准,Ⅰ期2例、Ⅱ期3例、Ⅲ期35例、Ⅳ期14例,本组Ⅲ、Ⅳ期5年生存率分别为34.3%、0,Ⅲ、Ⅳ期明显低于Ⅰ、Ⅱ期的生存率,经统计学处理有显著差异（P〈0.01）。冷冻活检者23例,有复发转移13例,3、5年生存率为43.5%35.5%、常规活检者31例,有复发转移26例,3、5年生存率为30.4%25.8%。原发灶手术治疗组与原发灶综合治疗组3、5年生存率两组经统计学处理有显著的差异（P〈0.01〉。共50例颈淋巴清扫术后淋巴结阳性检出率70.0%（35/50）。54例3年生存率38.9%、5年生存率27.8%、3例存活10年以上。结论：冷冻活检是术前正确的诊断方法,利于减少复发提高生存率,颈淋巴清扫是必要。原发灶冷冻、手术扩大切除病灶、颈淋巴清扫术、术后免疫治疗和放化疗的综合序列治疗能明显提高恶黑患者的生存率。     

干扰素对上颌黏膜恶性黑色素瘤生存率的影响

目的:评价2种辅助治疗方案对口腔黏膜恶性黑色素瘤患者生存率的影响。方法:回顾性生存分析。上颌黏膜恶性黑色素瘤术后患者165例,分为3组:Ⅰ组,单纯手术作为对照组,50例;Ⅱ组:手术 干扰素-α2b治疗组,78例;Ⅲ组:手术 干扰素-α2b 氮烯咪胺治疗组,37例。所有患者AJCC2000分期均为Ⅱ、Ⅲ期。Cox比例风险模型用于预后因素筛选,Kaplan-Meier法计算不同治疗措施下各组的3年累积生存率,Log-rank法用于各组间两两比较。结果:3年总生存率为4%,其中Ⅰ组为3%,Ⅱ组为4.5%,Ⅲ组为5.7%。肿瘤厚度(P<0.001,RR=2.696)、有无破溃(P<0.001,RR=2.068)、淋巴结转移(P<0.001,RR=1.710)和治疗方法(P<0.001,RR=0.395)是影响生存率的主要因素。2种辅助治疗方法对提高生存率均有显著影响(P均<0.01),但2年后作用逐渐减退。2种辅助治疗方法间无统计学差异(P=0.925)。结论:2种辅助治疗措施对提高生存率的影响在2年内显著,随时间逐渐消失。干扰素-α2b 氮烯咪胺方法效果并不优于单纯使用干扰素-α2b。     

颅底区恶性肿瘤的诊断和治疗探讨

目的 探讨颅底恶性肿瘤的诊断和治疗，以提高患者5年生存率。方法 通过对1991-1997年间12例住院并施行颅底恶性肿瘤手术的病例随访跟踪。分析其治疗效果。结果 随访最长达7年，5例生存，7例死亡；5年生存率为41.7%.结论 (1)采用颅颌面联合切除可以延长患者生命.(2)影响患者预后因素很多,很复杂,除治疗方法外,还与肿瘤的大小、病理性质等因素有关。主张早诊早治。（3）手术加放疗比任何一种单一治疗为好。     

腺样囊性癌患者生存预测模型的建立

目的通过分析唾液腺腺样囊性癌（SACC）患者的病历资料,建立生存预测模型,并探讨其临床应用价值.方法分析118例有完整随访资料的SACC患者的病历资料,选择10个可能对患者预后产生影响的临床病理因素,通过Cox模型进行多因素分析,建立预后指数方程.然后根据预后指数（PI）将患者分为高、中、低危险3个组,应用Kaplan-Meier法绘制3个组的生存曲线,得到各组总的累积生存率及中位生存时间.结果Cox模型多因素分析显示：SACC确诊时的年龄、临床症状、TNM临床分期、治疗方式、手术切缘与总累积生存率有关（P＜0.05）.预后指数方程为PI=0.031X2＋0.665X5＋0.420X6-0.576X7＋0.999X10.根据预后指数分为低危险组（PI＜3.57）、中危险组（PI=3.57～4.50）、高危险组（PI＞4.50）,预后指数越小,患者预后越好.3组的中位生存时间分别为18年、7年和4年,10年总累积生存率分别为83.56%、31.45%和11.20%.结论生存预测模型能够较全面反映SACC患者的预后,可预测不同患者的生存率,为临床治疗提供参考.     

336例HPV相关性与非相关性口咽鳞癌患者生存分析

目的: 分析比较HPV相关性与非相关性口咽鳞癌（oropharyngeal squamous cell carcinoma,OPSCC）患者在新、旧版TNM不同分期情况下,患者生存及预后差异,为OPSCC的治疗策略与预后评估提供临床依据。方法: 收集2010年1月—2016年12月青岛大学附属医院手术治疗的原发OPSCC患者,采用p16免疫组织化学检测方法对病理标本重新进行评估,统计患者生存信息,并分别运用第7版、第8版TNM分期系统对肿瘤进行分期,记录新、旧版的降级情况,分析、比较HPV相关性与非相关性OPSCC患者两版不同分期对生存率及预后的影响。采用SPSS 25.0软件包对数据进行统计学分析。结果: 最终纳入336例OPSCC患者,其中HPV相关性OPSCC患者101例（30.1%）,5年生存率为47.5%（48/101）,中位生存时间58个月;非相关性OPSCC患者5年生存率为34.0%（80/235）,中位生存时间37个月。HPV相关性OPSCC患者第8版TNM分期与第7版TNM分期对比,其总体降级率为77.2%（78/101）,晚期患者降级率为100%（69/69）,晚期患者中降至早期的患者占比69.6%（48/69）。结论: HPV相关性OPSCC患者的生存率和生存中位时间明显优于非相关性OPSCC患者,第8版TNM分期手册的OPSCC分期相比第7版更符合临床实际,预后分层更加清晰,能更好指导临床决策。     

口腔粘膜原发恶性黑色素瘤的临床病理学研究

目的　研究口腔粘膜原发恶性黑色素瘤的临床病理特点及其与预后的关系。方法　采用回顾性分析的方法对73例口腔粘膜原发恶性黑色素瘤进行了临床病理学研究并对有随访资料的患者进行Kaplan-meier生存曲线及Log rank检验的统计学分析。结果　口腔粘膜原发恶性黑色素瘤多发于40~60岁的男性,腭部和牙龈多见。临床分期以I期最多;病理分型中结节型多见,其次是雀斑样型和表浅扩散型;按细胞形态分型以混合细胞型最为多见,其次是上皮样细胞型和梭形细胞型。有随访资料的43例患者3年生存率为19·86%,5年生存率为11·91%;淋巴结转移、浸润深度、临床分期、病理分型和治疗方法与预后有关(P<0·05)。黑斑与病理分型有关(P<0·05),黑斑多见于雀斑样型口腔粘膜原发恶性黑色素瘤,且预后较好。结论　口腔粘膜恶性黑色素瘤是一种预后差的恶性肿瘤;有无黑斑和淋巴结转移、浸润深度、临床分期、病理分型、治疗方法等与预后有关。     

2种颈淋巴清扫术对口腔鳞状细胞癌cN0期患者疗效的对比分析

目的 对比分析肩胛舌骨上颈淋巴清扫术(supraomohyoid neck dissection,SOND)和传统根治性颈淋巴清扫术(classical radical neck dissection,CRND)对口腔鳞状细胞癌cN0期患者术后颈部复发率、生存率和生存质量的影响。方法 68例临床cN0期的口腔鳞癌患者随机分为2组:CRND组和SOND组均为34例。统计比较术后颈部复发率,应用SPSS10.0软件统计分析2组患者术后3年、5年生存率,用华盛顿大学生存质量问卷评价两组患者的生存质量。结果 CRND组和SOND组3年颈部复发率分别为8.8%、11.7%,5年颈部复发率分别为11.8%、14.7%;CRND组和SOND组3年生存率分别为69.1%、68.4%,5年生存率分别为55.6%、54.9%;CRND组和SOND组生存质量平均总分各为533.57±112.22,653.06±84.92,有统计学差异。因而对cN0期的口腔鳞癌患者行肩胛舌骨上颈淋巴清扫术与传统根治性颈淋巴清扫术相比,没有降低患者术后生存率和颈部复发率,但显著地提高了患者术后的生存质量。结论 肩胛舌骨上颈淋巴清扫术在cN0期口腔鳞癌患者的治疗上可以取代传统根治性颈淋巴清扫术。     

新辅助化疗对OSCC患者生存率和生存质量影响的研究

目的：探讨新辅助化疗对口腔鳞癌（OSCC）患者生存率和生存质量的影响。方法：132例T3、T4 OSCC患者随机分为2组：Ⅰ组（单纯手术）75例：Ⅱ组（新辅助化疗＋手术）57例，应用SPSS 10．0软件统计分析两组5年生存率和用华盛顿大学生存质量问卷评价两组患者的生存质量。结果：①Ⅰ组和Ⅱ组的5年生存率分别为42．8％、55．8％，两组间有显著性差异（P〈0．05）；新辅助化疗有效者和无效者5年生存率分别为66．5％、45．9％，两组间有显著性差异（P〈0．05）；Ⅱ组中新辅助化疗无效者和Ⅰ组5年生存率分别为45．9％、42．8％，两组间无显著性差异（P〉0．05）。②Ⅱ组生存质量总分显著高于Ⅰ组（P〈0．05）；Ⅱ组中新辅助化疗有效者显著高于无效者（P〈0．05）；Ⅱ组中新辅助化疗无效者与Ⅰ组无显著性差异（P〉0．05）。结论：有效的新辅助化疗能显著提高OSCC患者的生存率和生存质量。     

口腔粘膜恶性黑色素瘤18例临床分析

目的 对口腔粘膜恶性黑色素瘤（MM）作一回顾性总结。方法 对18例经治疗的MM患者临床表现、治疗及预后进行分析。结果 本组资料中的I、Ⅱ期病例有3例,Ⅲ、Ⅳ期病例有15例。前者采用手术治疗,后者采用病灶冷冻、手术为主并辅以化疗及免疫治疗的综合治疗,5年生存率达33.3%。结论 综合治疗有助于提高MM患者5年生存率。     

评述

该文收集山东省济南市5所医院收治的230例口腔黏膜恶性黑色素瘤的病例资料,重点对手术治疗后3年生存率的有关影响因素进行了多因素分析.结果指出：肿瘤厚度、淋巴结转移、肿瘤有无破溃及原发部位是影响生存率的相对独立因素;单纯手术治疗并非口腔黏膜恶性黑色素瘤的最佳措施.该文有以下几点值得特别提出与讨论.     

中国人口腔黏膜黑色素瘤临床诊治专家共识

头颈黏膜黑色素瘤（HNMM）是一类高度恶性的实体肿瘤,5年生存率长期徘徊在20%左右,其致病因素、驱动基因、临床表现及治疗手段等与皮肤黑色素瘤差异较大。2015年,国内首个头颈黏膜黑色素瘤诊治专家共识建立,经过6年多的推广应用, HNMM临床诊治规范性有了很大提高。随着黏膜黑色素瘤临床与基础研究的不断深入,HNMM的诊治与预后在近些年发生了较大变化,特别是头颈部各分支学科的蓬勃发展,口腔、鼻腔鼻窦、眼部等黏膜黑色素瘤各自发展出独特的诊治模式,该共识已不能满足当前临床的实际需求。对此,专家组认为头颈部黏膜包含的解剖范围较广,涉及的临床科室较多,不同学科之间黑色素瘤诊疗模式差异明显,临床亟须符合个体化治疗及精准治疗的更加专科化的诊治共识。为了进一步提高口腔黏膜黑色素瘤（OMM）的远期生存率和生存质量,让共识更好地指导临床工作,专家组聚焦 OMM,深入讨论,基于循证医学证据和经验医学,完成专家共识的制定。考虑到患者的个体化差异,本共识可作为OMM临床实践的参考。     

Primary malignant melanoma of the oral cavity: assessment of outcome from the clinical records of 35 patients

Oral malignant melanoma is extremely rare and carries a poor prognosis. The treatment of choice remains controversial. We retrospectively studied 35 patients with primary malignant melanoma of the oral cavity between 1970 and 2001 to define the clinical features of this disease and evaluate treatment methods. The main variables studied were clinical findings, response to therapy, and outcome. Surgery with complete macroscopic resection was performed at the primary site in 13 patients (surgery group) and radiotherapy was done without surgery in 17 (non-surgery group). The 5-year cumulative survival rate was 15.4% in the surgery group, 35.3% in the non-surgery group, and 21.8% overall. Distant metastasis was present in 64.7% (11/17) of the non-surgery group and 76.9% (10/13) of the surgery group. Improved outcome in oral malignant melanoma requires the development of new therapies and the prevention of distant metastasis.     

Intraoral melanoma: long-term follow-up and implication for dental clinicians. A case report and literature review

Primary intraoral melanoma is a rare neoplasm with a poor prognosis, accounting for 1% to 8% of all melanoma in Europe and the United States. The incidence (12%) and 5-year survival rate (17.4%) are higher in Japan. We report a case of oral lentiginous melanoma in a Japanese-American man who survived disease-free for more than 5 years after surgery, radiation therapy, and chemotherapy but developed chronic mucositis of the palate under the denture in the primary radiated field. This lesion responded to antifungal therapy. Subsequent multiple biopsies ruled out the recurrence of melanoma but demonstrated prolonged melanocytic hyperplasia and focal epithelial atypia. We reviewed clinical differences in oral melanoma reported in the United States and Japanese literature, and describe the wide variety of oral clinical features of postoperative radiation and chemotherapy, as well as the oral tissue changes caused by denture-induced mucositis and candidiasis in such patients. Dental clinicians should conduct a thorough head, neck, and oral follow-up with increased vigilance in patients with a history of prior cancer.     

Recent advances in the management of cutaneous malignant melanoma: our case cohort

Decades of research into the management of cutaneous malignant melanoma have proven it to be a ‘tough nut to crack’, and its incidence has continued to increase over the last 30 years. Surgery remains a gold standard for early-stage melanoma with five-year survival of 98% for stage I disease, and 90% for stage II. Nonetheless, patients with stage III disease are at a higher risk, resulting in local recurrence as well as distant metastasis. Research regarding the control of metastatic malignant melanoma of the head and neck has evolved. Currently the search is on to understand metastatic malignant melanoma as a heterogeneous disease both at the molecular and clinical level. This paper focuses on the latest systemic therapy for metastatic disease of the head and neck, including cytotoxic chemotherapy, immunotherapy, and target therapy. The new eighth edition of tumour staging, and the sequelae for malignant melanoma, sentinel lymph node biopsy (SLNB), surgical intervention, and its benefits and shortfalls, are discussed. Also, the outcome of our cohort series of patients with metastatic cutaneous malignant melanoma who were treated with systemic combination therapy in Dorset is presented.     

The fate and survival of amalgam and preformed crown molar restorations placed in a specialist paediatric dental practice

The fate of 1688 amalgam restorations and 716 preformed crowns placed in permanent and primary molars in a specialist paediatric dental practice over a 10-year period by one operator is reported. For primary molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were, for Class 1 restorations, 16.1%, 3.9%, 73.3%, respectively, with an estimated median survival time greater than 8.5 years, and for Class 2 cavities 14.7%, 11.6%, 66.6%, with an estimated median survival time greater than 7.5 years. For permanent molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were for Class 1 restorations 11.5%, 6.5%, 76.8%, respectively, with an estimated median survival time greater than 9.3 years, and for Class 2 restorations 9.8%, 8.0%, 82.2%, with a median survival time greater than 8.5 years. For all preformed crowns, the replacement rate, true failure rate and 5-year survival estimates were 2.8%, 1.9%, 92.0%, and the estimated median survival time greater than 7.64 years. No relationship was observed between the age of the patient and the age of replaced restorations. No significant difference was found between the survival rates of Class 1 and 2 amalgam restorations in primary or permanent molars, nor between first and second primary molars.     

颌面颈部恶性淋巴瘤──附88例病例报告

我科自1983年7月～1996年7月共收治住院的ML病人88例，其中男性60例，女性28例，年龄0．5～80岁，中位年龄为42岁。何杰金病（HD）7例，非何杰金淋巴瘤（NHL）81例。与本校综合医院1992年以后同期收治的ML病人比较，颌面颈部ML病人占10．7％～23．6％。39例病人接受综合治疗，33例接受单纯化疗。随访病人存活时间超过7年者7例，超过5年者9例。存活病人中以临床Ⅰ、Ⅱ期者占绝大多数，而死亡病人中以Ⅲ、Ⅳ期居多。死亡病人平均存活23．6月（4～55个月），中位存活时间为12个月。研究结果提示：1．颁面颈部ML发病有明显增长趋势，应引起足够重视。2．对颌面颈部诊断不明的包块应不惜反复活检以确定诊断，特别是对T系ML。3．以化疗为主的综合治疗仍是有效的主要手段。4．临床分期对估计预后有重要的参考价值。     

Progression of proximal caries in the mixed dentition: a 4-year prospective study

PURPOSE: The purpose of this study was to investigate the survival rate and median survival time of different stages of proximal caries in 196 children aged 6 to 8 years at baseline examination. METHODS: Proximal caries and its progression were diagnosed from bitewing radiographs taken at 1-year intervals over a period of 4 years. The mesial surface of the first permanent molars, the mesial and distal surfaces of the first and second primary molars, and the distal surface of the primary canine were examined. Sound surfaces, caries lesions in the external- and internal-half of the enamel and external-, middle-, and internal-third of the dentin, as well as filled, extracted, and exfoliated teeth were recorded. A life table analysis was performed to estimate the annual and cumulative survival rates and the median survival time of each state of proximal lesions. RESULTS: For the sound mesial surfaces of the first permanent molars, the cumulative survival rate was 76% and the median survival time was over 48 months. The corresponding values for the external-half of the enamel lesions were 41% and 45 months. Regarding the sound mesial and distal surfaces of the primary teeth, the cumulative survival rate was 92% and the median survival time was over 48 months. The corresponding values for the external and internal-half of the enamel lesions were 40% and 31 months, and 29% and 22 months, respectively. The value of the cumulative survival rate for the external-third of dentin lesions was 42%, with a median survival time of 34 months, and the value for the middle-third of the dentin was 38% with a median survival time of 17 months. CONCLUSIONS: The risk of developing carious lesions in the sound proximal surfaces of both primary teeth and first permanent molars is low during the mixed dentition period; the progression of the external-half of enamel lesions of the first permanent molars is low for the first 3 years and becomes faster thereafter; and as the time period that the tooth exposed to cariogenic factors increases, the progression of the proximal caries is faster for all stages of the lesion in the primary teeth.