口腔鳞癌腮腺淋巴结转移的临床病理特征与预后分析

目的:探讨口腔鳞癌患者腮腺淋巴结转移的临床病理特征及预后影响因素.方法:回顾性分析2003年1月—2017年12月上海交通大学医学院附属第九人民医院收治的60例伴或不伴腮腺淋巴结转移的口腔鳞癌患者的临床病理资料及影像学资料,分析其临床病理和影像学特征及其与预后的相关性.采用SPSS 23.0软件包对数据进行统计学分析....     

XIAP与口腔鳞癌局部淋巴结转移关系的研究

目的 探究XIAP的表达水平与口腔鳞癌局部淋巴结转移之间的关系。初步评价其表达水平是否可以作为预测口腔癌局部淋巴结转移新的靶基因。方法 收集40例原发口腔鳞癌标本及11例术后复发标本,运用免疫组化技术检测组织标本中XIAP蛋白的表达水平,评价其表达水平与淋巴结转移等临床参数之间的相关性。结果 40例原发口腔鳞癌标本中XIAP在细胞胞浆中均有不同程度的表达,其表达水平与淋巴结转移、病理分级及复发显著相关。结论 实验结果表明,细胞胞浆中XIAP的表达水平与口腔鳞状细胞癌局部淋巴结转移及术后复发密切相关,可能是口腔鳞癌淋巴转移新的促进基因。     

Primary squamous cell carcinoma of the parotid gland: clinicopathological characteristics,treatment, and prognosis

Squamous cell carcinoma (SCC) of the parotid gland is a rare aggressive malignancy with a poor prognosis. The clinical behaviour, histopathological characteristics, and treatment strategies for parotid SCC still need to be comprehensively demonstrated. In this study, a retrospective review of patients diagnosed with parotid SCC was performed, covering the past two decades. Twenty-nine patients with primary parotid SCC and 10 patients with recurrent parotid SCC were identified. The clinicopathological characteristics of parotid SCC were summarized. Imaging records were used to determine the extent of invasion of the parotid SCC. Histopathological alterations in the parotid resulting from the infiltration of SCC were demonstrated. A set of treatment strategies was developed, involving parotidectomy, neck dissection, facial nerve treatment, defect repair, adjuvant radiotherapy, and chemotherapy/targeted therapy. The median patient survival was 24 months for those with primary parotid SCC and 14.5 months for those with recurrent parotid SCC. Comparatively, patients with a larger tumour size of primary parotid SCC experienced poorer overall survival (hazard ratio 8.986; P = 0.013). Great efforts have been made over the past two decades to identify and treat parotid SCC. Consensus regarding therapeutic options for parotid SCC has not been widely achieved and there is still a great need for well-designed prospective studies.     

腮腺原发性鳞状细胞癌的治疗及预后分析

目的 总结分析腮腺原发性鳞状细胞癌的预后相关因素及治疗策略.方法 回顾分析1970年3月至2005年3月收治并经病理证实的49例腮腺原发性鳞状细胞癌的临床资料,对有完整随访资料的44例应用SPSS 13.0统计软件进行分析.结果 44例获得随访患者的中位随访时间为38个月(5～215个月),术后21例复发、转移(腮腺局部或颈部淋巴结转移13例、伴有远处转移8例),局部复发是治疗失败的主要原因.49例中3年、5年的累计生存率为52%、27%,无瘤生存率分别为34%、16%.Kaplan-Meier和log-rank单因素分析显示,患者年龄、肿瘤大小、远处转移、术后放疗、面神经功能障碍、皮肤侵犯、术式及手术切缘、颈淋巴结清扫术均对患者的生存率有影响.Cox多因素分析结果表明,年龄、面神经功能障碍、远处转移及手术切缘是影响腮腺原发性鳞状细胞癌预后的重要因素.结论 手术及术后放射治疗是腮腺原发性鳞状细胞癌的最佳治疗方案,可以明显改善患者预后,降低术后复发率.     

Supraclavicular lymph node recurrence after radical surgery: is epidermal growth factor receptor a predictive marker?

The aim of this study was to evaluate the rare postoperative supraclavicular metastasis originating from oral squamous cell carcinoma (OSCC) and to discuss epidermal growth factor receptor (EGFR) as a potential predictive marker. Tumour specimens of OSCC patients divided into three groups were included: supraclavicular metastasis (n = 8), conventional cervical metastasis (n = 28), no metastasis (n = 48). Basic information and EGFR expression were compared among these groups and the data were analysed to identify potentially related risk factors for supraclavicular metastasis. In the supraclavicular metastasis group (n = 8), all primary tumours were T1–T2 and located in the tongue and buccal region; five of eight cases were pathologically N0. The median interval from the primary tumour resection to the development of supraclavicular metastases was 21.5 months. All related deaths (5/8) occurred within 2 years. In the supraclavicular metastasis group, EGFR expression was highest in the supraclavicular metastases, followed by cervical lymph nodes, and was lowest in the primary tumours (P = 0.39). In contrast, in the conventional metastasis group and the N0 group, EGFR expression was higher in the primary tumours than in the lymph nodes (P < 0.01). Supraclavicular metastasis of OSCC is infrequent and associated with a poor prognosis. EGFR might predict the occurrence of supraclavicular metastasis.     

Incidence of metastasis to level V lymph nodes in clinically positive necks among Sri Lankan patients with oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) remains the most common cancer among males in Sri Lanka. Metastasis to neck is a crucial prognostic factor. A modified radical/radical neck dissection including levels I –V, was performed in patients with OSCC who had a clinically positive neck (cN+). Currently, evidence suggests that sparing level V in a cN+ may be justified due to less chance of metastasis in early stages of the disease. To the best of our knowledge, the incidence of metastasis to level V in patients with cN+s has not been previously investigated in a Sri Lankan context. We aimed to determine level V lymph node metastasis and related clinicopathological indicators in cN+s in patients with OSCC. A multicentre retrospective study investigated postoperative biopsy reports of 187 patients for five years. OSCC patients with cN+s who underwent neck dissections of levels I-V were included. Only 6.4% of patients had histopathologically positive level V lymph nodes. A total of 127 lymph nodes were harvested from level V of those who showed level V positivity and out of them 68 were positive with a third of cases showing extranodal extension (ENE). The buccal mucosa (n=4) and lateral aspect of the anterior two thirds of the tongue (n=4) were the common primary sites for level V metastasis. In patients who showed positivity in levels III and IV, a considerably higher probability of level V nodes being positive was seen, which was statistically significant (p = 0.0001). We have concluded that the routine performance of a modified radical/radical neck dissection for cN+s should be stopped, as the incidence of Level V positivity is significantly low. Assessing the cN+ for N stage, status of levels III and IV, pattern of invasion, differentiation, and the site may be used instead as predictors for level V positivity.     

超声刀辅助下腮腺良性肿瘤功能性包膜外切除术的临床效果评价

目的 探讨超声刀辅助下功能性包膜外切除术（harmonic scalpel assisted extracapsular dissection,HS-ECD）治疗腮腺良性肿瘤的临床效果。方法 回顾分析2013—2017年3家医疗机构使用HS-ECD术式进行治疗且资料齐全的132例腮腺良性肿瘤患者,根据肿瘤位置分为浅叶耳屏前、浅叶下极、腮腺深叶组,收集术中、围术期各项指标和并发症发生率,以及随访期内肿瘤复发率。采用SPSS 16.0软件包对数据进行统计学分析。结果 深叶组手术时间与术后引流时间较长,术中失血量与引流量较多（P<0.01）;深叶组面神经损伤概率较高（P=0.022）,耳大神经损伤、腮腺筋膜损伤及肿瘤包膜破裂3组间无显著差异（P>0.05）;深叶组术区皮肤感觉减退及涎瘘发生率较高(P=0.004、0.043);创口感染与味觉出汗综合征的发生率组间无显著差异（P>0.05）;深叶组暂时性面瘫发生率显著升高（P<0.01）,永久性面瘫发生率组间无显著差异（P=0.052）;肿瘤复发率3组间无显著差异（P=1.000）。结论 HS-ECD术式对腮腺良性肿瘤患者效果良好。术中切口缩小,组织损伤减轻;术后面型良好,功能保存完善,术后并发症发生率有效降低,肿瘤复发率控制良好。     

Extracapsular dissection of pleomorphic adenoma of the parotid gland through minimal preauricular and retroauricular incisions in children

We evaluate treatment outcomes in children with benign parotid neoplasms who underwent extracapsular dissection of the tumor using minimal incisions. Nine pediatric patients (4 boys and 5 girls) with pleomorphic adenoma of the parotid gland were treated with extracapsular dissection via preauricular and retroauricular incisions. The mean age of the patients at the time of surgery was 9.4 years. The size of the tumors ranged from 1.5 × 1.4 to 3.5 × 3.0 cm. Seven tumors were located in the superficial lobe of the parotid gland and 2 were located in the deep lobe. All histologically confirmed cases of malignancy were excluded. All 9 operations were performed successfully. No patient exhibited any permanent postoperative complication. Neither hematomas of the parotid region nor salivary fistula occurred. One patient had slight transient postoperative facial paresis. The scars were almost invisible. All patients had excellent cosmetics and complete function of the facial nerve. The patients were followed up for 5.1 to 7.0 years. Tumor recurrence developed in 1 patient who subsequently underwent curative parotidectomy. Extracapsular dissection through preauricular and retroauricular incisions is a feasible technique, providing excellent cosmetic outcome in the treatment of benign parotid neoplasms in children.     

An update on the latest evidence for managing the clinically negative neck (cN0) in oral squamous cell carcinoma

The single most important prognostic indicator for survival in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastases in the neck. While the treatment of the clinically node positive (cN+) neck is well established, the management of the clinically negative neck (cN0) is controversial. Various strategies have been advocated including close observation including regular ultrasound imaging, elective neck dissection and sentinel lymph node biopsy. Neck dissection surgery is not without potential morbidity with shoulder dysfunction being the main complication. A number of factors are associated with increased risk of neck node metastasis including primary tumour thickness and peri‐neural invasion. A recent prospective randomised trial has found survival benefit following neck dissection even in patients with a cN0 neck at presentation. We discuss the latest evidence for managing the cN0 in OSCC and include our own experience on the role of neck dissection in certain cases.     

腮腺浅叶多形性腺瘤两种切除术式的疗效比较

目的：对腮腺行部分切除术治疗腮腺浅叶多形性腺瘤的手术疗效经进行系统评估。方法：回顾分析2006~2010年我科诊治的128例腮腺浅叶多形性腺瘤患者,其中60例患者采用腮腺部分切除术的为A组,68例患者采用腮腺浅叶切除术的为B组,比较两组患者的手术切口长度、手术时间和术后并发症,从而判定手术疗效以及患者术后功能恢复状况。结果：与B组相比,A组患者的手术时间短,切口小,具有统计学差异（P〈0．05）,且A组患者术后各项并发症发生率低,具有统计学差异（P〈O．05）。结论：腮腺部分切除术手术创伤小、并发症少,疗效优于浅叶切除术。目前可作为治疗腮腺浅叶多形性腺瘤的较好方法。     

Retropharyngeal lymph node metastasis in oral cancer. Systematic review and survival analysis

IntroductionMetastasis to retropharyngeal lymph nodes (RPLN) from oral squamous cell carcinoma is rare and associated with poor outcomes. The poor prognosis of RPLN is multifactorial and includes the clinicopathological aggressiveness of the primary disease and the late presentation. The aim of this systematic review is to assess the evidence on RPLN in patients diagnosed with oral squamous cell carcinoma (OSCC), the quality of the diagnostic modalities and the available treatment options. We aimed to analyse the overall survival of these patients diagnosed with RPLN.MethodsA systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The initial literature search generated 289 articles. A total of 11 papers satisfied our criteria. Eight papers provided enough data to perform survival analysis and 3 papers compared the diagnostic modalities used in the detection of RPLN.ResultsA total of 73 OSCC patients diagnosed with RPLN metastasis were identified. The most common primary tumour subsites included the tongue (20), buccal mucosa (15) and gingiva (11). The cumulative 5-year OS rate was 17.8% while the 2-year overall survival was 35.9%.ConclusionThe presence of nodal metastasis is an independent prognostic factor in head and neck cancer. In this study, RPLN metastasis had a poorer prognosis (5 years overall survival is 17.8%) when compared to the survival rate of oral cancer without RPLN metastasis (5 years overall survival is 40%). There was no statistically significant difference between the overall survival in primary RPLN metastasis and recurrent RPLN disease.     

腮腺浅叶肿瘤切除术中腮腺主导管存留的临床评价

日的:评价腮腺浅叶肿瘤切除术中腮腺主导管保留的临术效果.方法:对66例临床诊断为腮腺浅叶良性肿瘤的病例,作解剖和保存面神经及腮腺主导管,切除腮腺浅叶及其肿瘤术.结果:(1)术后无肿瘤复发,(2)术侧无明显凹陷性畸形,(3)术后涎瘘明显减少.结论:腮腺主导管及其深叶的保留与肿瘤复发无关,该术式适应腮腺浅叶及峡部的良性肿瘤.     

Feasibility of using the postauricular-groove approach without endoscopic assistant for excision of parotid tumors. Results from a series of 58 cases

The aim of the study was to evaluate the efficacy and preliminary outcomes of using a postauricular-groove approach without endoscopic assistance for the excision of parotid tumors.Patients who underwent parotidectomy using a postauricular-groove incision were selected for this study. For patients in which parotidectomy was difficult, namely, for tumors located in the deep lobe area, the parotid gland sternocleidomastoid space was fully utilized, and the tumor was resected from the posterior plane. A total of fifty-eight patients with parotid tumor were enrolled and divided into superior lobe group (n = 46) and deep lobe group (n = 12). The difference in operation time (94 vs 119 min) and postoperative drainage (20.18 vs 45.33 mL) was statistically significant between the tumors in the superficial and deep lobes. However, postoperative cosmetic VAS score was 10 (extremely satisfied) for all patients. The incidence of transient facial nerve paralysis was comparable (8.7% vs 16.7%), and all of them resolved spontaneously within 3 months. No recurrence of tumors was found in either group in the median follow-up interval of 26.45 months (range 22.2–35.3 months), which was comparable to the result using the conventional “S” approach.After making full use of the parotid gland sternocleidomastoid space, the postauricular-groove approach demonstrated satisfactory facial nerve protection, as well as easy maneuverability without the risk of surgical complications for tumors located in the deep lobe area. Importantly, the postauricular-groove approach showed excellent cosmetic outcomes for all patients and should be considered an alternative approach for parotidectomy of selected cases.     

口腔鳞状细胞癌肿瘤相关成纤维细胞的研究进展

口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)是头颈部最常见的恶性肿瘤,与其他恶性肿瘤相似,其肿瘤相关成纤维细胞(cancer-associated fibroblasts,CAFs)是肿瘤微环境中最重要的间质细胞,在肿瘤的增殖、转移、免疫耐受及治疗抵抗等方面发挥重要的调控作用。本文就OSCC中CAFs研究进展及其对临床治疗的启发,建立CAFs作为干预靶点,打破肿瘤细胞赖以生存的微环境,干扰肿瘤细胞的生长和侵袭,有效阻断肿瘤新生血管的形成,激活机体免疫功能,为OSCC辅助治疗提供新的思路和策略。     

111例cN0口腔鳞状细胞癌患者颈部淋巴结转移临床分析

目的 探讨颈部淋巴结阴性（clinically negative cervical lymph node,cN0）的口腔鳞癌（oral squamous cell carcinoma, OSCC）患者发生颈淋巴结隐匿性转移的规律和相关影响因素。方法 收集承德医学院附属医院2007年5月—2017年5月接受颈淋巴结清扫术的111例cN0口腔鳞癌患者的临床和病理资料,进行回顾性分析。采用SPSS 17.0软件包中χ²检验,分析隐匿性转移与年龄、性别、原发灶部位及病理分级的关系。结果 111例cN0口腔鳞癌患者中,总隐匿性转移率为27.03%（30/111）。cN0口腔鳞癌患者淋巴结转移率与性别、年龄及发病部位无显著相关（P>0.05）,与病理分期存在显著相关（P<0.05）。结论 肿瘤分化程度越低,颈淋巴结隐匿性转移率越高。临床上对此类患者,应积极行颈淋巴清扫术。     

Combined surgery and postoperative radiotherapy for oropharyngeal squamous cell carcinoma in Korea: analysis of 110 cases

The treatment of oropharyngeal squamous cell carcinoma (OSCC) remains controversial. This study reviews the authors' experience of treating OSCC, evaluates the oncologic outcome and assesses the factors affecting local/regional recurrence. A retrospective analysis of 110 consecutive OSCC patients treated primarily by surgery and/or postoperative radiotherapy was carried out. 82% of patients had advanced disease (stage III or IV). The 5-year overall survival and disease specific survival rates (DSSR) were 58% and 65%, respectively. The DSSR of the soft palate or posterior pharyngeal wall, tonsillar area, and base of tongue were 80%, 62%, and 51%, respectively (P<0.05). The 5-year DSSR according to the American Joint Committee on Cancer stages was 94% for early stage and 56% for advanced stage (P<0.05). The overall recurrence rate was 38% (42 patients). The most frequent site of recurrence was the neck (46%). Only 14% of patients with recurrences were treated successfully. Positive resection margins and the presence of pathologic lymph nodes influenced the recurrence at the primary lesion and in the neck, respectively, in a statistically significant manner. Surgery and postoperative radiotherapy provided a superior outcome in patients with advanced OSCC. A randomized study is required to assess the oncologic and functional superiority of surgery or chemoradiation.     

cN0口腔鳞癌患者Ⅱb区淋巴结转移102例研究

目的:统计cN0口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)患者Ⅱb区淋巴结转移情况,从而探讨择区性颈淋巴结清扫(selective neck dissection,SND)时处理Ⅱb区域的必要性.方法:收集我院口腔颌面外科2014年1月—2015年7月行颈淋巴结清扫术及原发灶手...     

口腔鳞状细胞癌患者颈部淋巴结特征与预后的关系

目的： 探讨口腔鳞状细胞癌（oral squamous cell carcinoma,OSCC）患者颈部阴性淋巴结临床、病理形态特征,并研究其与颈淋巴结转移、复发及总生存期的关系。方法： 回顾分析2017年1月—2021年1月新疆医科大学第一附属医院收治的100例OSCC患者的临床病理资料,研究终点事件为颈淋巴结转移、复发和死亡,采用Kaplan-Meier法绘制生存曲线,Cox生存分析法探讨不同因素与患者预后的关系。采用SPSS 21.0软件包对数据进行统计学分析。结果： 100例患者平均随访时间为30个月,失访10例。90例患者中,出现颈淋巴结转移、复发11例（12.2%）、死亡28例（31.1%）,阴性淋巴结出现窦组织细胞增生（sinus histiocytosis, SH）27例（30%）,3年无颈淋巴结转移复发率为89.4%,3年总生存率为67.3%。90例患者的Cox回归生存分析结果显示,分化程度、N分期、临床分期对总生存期有显著影响（P<0.05）;吸烟、初次颈淋巴结转移（N≠0）、SH、行双侧颈淋巴清扫术对颈淋巴结转移、复发有显著影响（P<0.05）,且吸烟、初次颈淋巴结转移、SH、行双侧颈淋巴清扫术患者的颈淋巴结转移、复发概率较高。结论： SH、初次颈淋巴结转移是导致OSCC患者颈淋巴结转移、复发的独立危险因素,N分期是导致患者死亡的独立危险因素。     

Parotid function after selective deep lobe parotidectomy

Selective deep lobe parotidectomy is a demanding technique, but it preserves healthy glandular tissue, improves cosmetic results and minimises the incidence of Frey's syndrome. We have evaluated postoperative function of the superficial lobe of the parotid after selective resection of the deep lobe. Fourteen patients who each had a mass involving the deep lobe of the parotid were selected from 127 patients with tumours of the parotid gland who were seen and treated between January 2001 and March 2004. Of the 14, 12 matched the study criteria. The preoperative diagnosis was made using both computed tomography (CT) and ultrasound or fine needle aspiration cytology, and the diagnosis was confirmed by histological analysis. All cases were treated by the same surgeon. At 6 months follow-up all patients had a House-Brackmann test, iodine starch test, and scintigraphy of both parotid glands. After scintigraphy the maximum uptake value and function of the gland were evaluated with the concentration index (CI) and the CI percentage ratio. The concentration function of the gland in the resected side of the study group had a mean (S.D.) CI index of 5.5 (3.6) and a CI percentage ratio of 84%. Selective deep lobe parotidectomy has the following advantages: it minimises the impact of treatment on the facial contour, it does not increase postoperative morbidity and it preserves the function of the gland.     

Differential expression of E-cadherin in metastatic lesionscomparing to primary oral squamous cell carcinoma

BACKGROUND: The main cause of treatment failure in resectable oral squamous cell carcinoma (OSCC) is metastasis. E-cadherin (E-cad) plays a principal role in cell adhesion and motility, and is associated with OSCC progression. The aim of this study was to investigate the clinical significance of E-cad expression in OSCC with lymph node metastasis which had radical neck dissection done. METHOD: Immunohistochemistry was used to detect E-cad expression in normal oral mucosa (NOM) (n = 10), oral precancerous lesions (OPLs) (n = 20), primary OSCC (n = 45), and their paired metastatic lesions (n = 45). E-cad immunoreactivity correlated with the clinicopathologic features. RESULTS: E-cadherin immunoreactivity was progressively reduced in the NOM followed by OPLs and primary OSCC (58%). It decreased significantly in the advanced stages of OSCC. However, the increase in E-cad immunoreactivity was observed in the majority (60%) of metastatic lesions in relation to primary OSCC. Patients with such increased or positive immunoreactivity of E-cad in metastatic lesions exhibited worse prognosis. CONCLUSION: The findings suggested a dynamic change in E-cad immunoreactivity during tumorigenesis and metastasis of OSCC. In a multivariate analysis, E-cad immunoreactivity in metastasis lesions (odds ratio 3.74, 95% CI 1.15-14.67; P = 0.040) implied the potential role of mortality predictors for OSCC cases with nodal involvement.