口腔舌鳞状细胞癌的临床分析

目的:总结口腔舌鳞状细胞癌的治疗经验以指导临床。方法:回顾性分析1975年1月～2000年12月初次在我院诊治的329例口腔舌鳞状细胞癌患者的临床资料。T1病变82例,T2病变190例,T3病变43例,T4病变14例。综合治疗186例,单纯手术84例,单纯放疗59例。结果:91例患者组织学检查颈部淋巴结转移,其中Ⅰ区淋巴结转移36例,Ⅱ区淋巴结转移65例,Ⅲ区淋巴结转移18例,Ⅳ区淋巴结转移10例。T1病变患者5年和10年累积生存率分别为72.23%和65.21%,T2分别为38.38%和33.11%,T3分别为10.63%和10.63%,T4分别为7.14%和7.14%(P=0.0000,Logrank=75.99)。单纯手术组患者5年和10年累积生存率分别为56.13%和47.28%,单纯放疗组分别为17.49%和17.49%,综合治疗组分别为43.51%和39.04%(P=0.0000,Logrank=42.23)。结论:口腔舌鳞状细胞癌早期病变可考虑单纯手术,而中晚期应给予综合治疗,对中晚期cN0患者可考虑扩大的肩胛舌骨肌上清扫术。     

Postoperative split course radiotherapy of squamous cell carcinoma of the oral tongue.

Forty nine patients with squamous cell carcinoma of the oral tongue were irradiated postoperatively using a split course technique for external irradiation alone or in combination with intraoral cone X-ray therapy. After a 3 year follow-up the results of local control were compared with those of other authors, who irradiated initially with combined external and interstitial therapy in one series. For two series the nominal standard dose (NSD) was calculated with the modified Ellis formula given by Gabriel-Jurgens et al.¹⁰ and Gremmel et al.¹¹ In our patient collective the recurrence rate was higher in the early T-stages, because the dosage applied was lower than in the majority of the cited publications. The combined modality of surgery and following external irradiation could not improve the outstanding results of interstitial therapy in T1 and T2 tumors.When the split course technique is used, the total dose and treatment time must be increased to obtain the same local control rate as in one series irradiation. Especially in advanced cases the split dose regimen seems to be an alternative treatment, because severe complications were not observed in our patients. For split course therapy we recommend the application of 1700 ret for Stage T1 oral tongue carcinoma 1800 ret for Stage T2 and 1900 ret for T3 tumors. For treatment of recurrences, surgery appears to be superior to irradiation.     

Analysis of recurrence of squamous cell carcinoma of the uterine cervix after definitive radiation therapy alone: patterns of recurrence, latent periods, and prognosis

A retrospective analysis was performed with emphasis on the patterns of recurrence, latent period, and prognosis in patients with cervical squamous cell carcinoma of the uterus treated with definitive radiation therapy alone. Late recurrence, which was observed more than 5 years after the initial radiation therapy, was finally focused on and discussed.

Between 1976 and 1994, 256 patients with squamous cell carcinoma of the uterine cervix without hematogenous metastasis were treated with definitive radiation therapy alone. The patients were staged as follows according to the FIGO classification: 26 in Stage I, 56 in Stage II, 124 in Stage III, 28 in Stage IVa, and 22 in Stage IVb. All the patients were treated with external beam irradiation and low-dose-rate intracavitary brachytherapy.

A total of 74 patients had recurrence. The recurrence appeared in 67 cases (90.5%) within 5 years. Metastasis to para-aortic and/or supraclavicular nodes developed later than other types of recurrence. Among patients with lymphogenous metastasis, there were more 5-year survivors after recurrence than with other types of recurrence. Patients with early recurrence, within 2 years of the initial therapy, had a worse prognosis than those with recurrence more than 2 years after treatment. Seven patients (2.7%) in all developed late recurrence more than 5 years after the treatment. The first site of recurrence was an abdominal para-aortic or supraclavicular node in all patients, excluding one patient who developed intrapelvic lymph node metastasis. Six patients had pelvic node metastasis detected with lymphangiography at the initial treatment. Median survival after late recurrence was 16.0 months. Two of 7 patients survived more than 3 years after secondary radiation therapy, and the remainder died of recurrent disease.

Patients with para-aortic and/or supraclavicular node metastasis that developed late after the initial treatment are more likely to survive due to secondary radiation therapy. Careful follow-up is emphasized for long-term survivors.     

Analysis of time-dose factors in clinically positive neck nodes treated with irradiation alone in squamous cell carcinoma of the head and neck

This is a retrospective analysis of time-dose factors in 139 patients with 238 evaluable clinically positive lymph nodes treated with external beam radiation therapy alone to the primary lesion and neck for squamous cell carcinoma of the head and neck at the University of Florida from October 1964 through April 1980. Lymph node control by lymph node size was 8/8 (100%) for less than 1.0 cm, 51/62 (82%) for 1.0 cm, 68/82 (83%) for 1.5-2.0 cm, 24/40 (60%) for 2.5-3.0 cm, 24/38 (63%) for 3.5-6.0 cm, and 0/8 (0%) for greater than or equal to 7.0 cm. Lymph node control was also influenced by dose, overall treatment time, and fractionation schedule; these factors were interrelated and appeared to increase in importance as the size of the lymph node increased.     

Surgical management of squamous cell carcinoma of the floor of the mouth

A retrospective review is presented of 76 patients, referred to the National Cancer Center Hospital, Tokyo, who underwent surgical management for squamous cell carcinoma of the floor of the mouth during the period March, 1969, to May, 1988. Of the 76 patients, 34 (45%) were treated by surgery alone, 19 (25%) by cryosurgery and 23 (30%) by a combination of surgery and another treatment modality, either irradiation (22 patients) or chemotherapy (one patient). Fifty-three percent of the patients had stage III or IV disease. Twenty-two patients (29%) developed recurrent disease during follow-up. Eighty-five percent of the treatment failures were identified within 24 months of treatment. The most common site of recurrence, seen in 14 out of 22 cases, was the neck. The actuarial five-year survivals for patients were: stage I disease, 96%; stage II, 79%; stage III, 66%; stage IV, 49%. Recent technical advances, allowing extensive resection and reconstruction in the surgical management of this kind of tumor, have improved the prognosis even for patients with advanced disease.     

早期舌鳞癌复发原因及预后因素的分析

背景与目的：早期舌癌的治疗效果理想,但复发是影响早期舌癌治疗效果的重要因素。本研究回顾性分析227例早期舌癌的临床资料,探讨早期舌癌复发的主要原因及影响预后的因素。方法：收集中山大学肿瘤防治中心1992—2003年首治的227例早期舌鳞癌患者的临床资料,Kaplan—Meier法对各影响因素进行生存率分析并计算生存率,log-rank法比较各因素不同水平生存分布的差异。Cox同归模型进行多因素分析,影响复发不同因素间比较用卡方检验。结果：高分化鳞癌组复发率为19.3％,中高低分化鳞癌组复发率为39．2％,二者的差异具有统计学意义（P=0．004）,综合治疗组复发率为15％,单纯手术组复发率为28％．二者的差异具有统计学意义（P=0．014）。复发组及非复发组3年及5年生存率分别为40．7％、87.3％及25．9％、80．3％,二者的差异具有统计学意义（P=0.000）。行颈清扫组及未行颈清扫组3年及5年生存率分别为为76．4％、75．0％及68％、61．2％．二者的差异具有统计学意义（P=0．023）;≥45岁组及〈45岁组3年及5年生存率分别为75．6％、78％及59．5％、66．1％,二者的差异具有统计学意义（p=0．021）。结论：病理分级及是否进行综合治疗是影响早期舌癌复发的原因,患者的年龄、是否行颈清扫、是否复发是影响早期舌癌预后的因素,年龄及是否复发是影响预后的独立因素。     

微波组织凝固在口底鳞癌治疗中的应用--26例总结

目的:探讨微波组织凝固在治疗口底鳞癌中的价值.方法:中山医科大学肿瘤医院头颈科自1989年至1993年应用微波组织凝固治疗方法对26例口底鳞癌患者的原发灶进行治疗,其中Ⅰ期2例,Ⅱ期11例,Ⅲ期10例,Ⅳ期3例.在微波治疗前,先行颈清扫术;大部分患者同时行颈外动脉舌动脉结扎.6例Ⅲ、Ⅳ期患者还结合辅助放疗或/和化疗.结果:本组病例5年生存率为61.5%(16/26);其中Ⅰ期为100%,Ⅱ期72.7%(8/11),Ⅲ期50%(5/10),Ⅳ期33.3%(1/3).有4例在2年内原发灶复发,占15.4%;3例出现颈淋巴结转移,占11.5%;3例出现远处转移,占11.5%.创面出血、舌根后坠和呼吸困难是主要的术后并发症.结论:微波组织凝固应用于口底鳞癌原发灶的治疗,其生存率及复发情况与用传统手术方法治疗的结果接近,在保全口腔功能及面部外形方面优于传统治疗方法.     

cN0舌鳞癌患者预后的多因素分析

背景与目的：cNO舌活动部鳞癌的治疗尚存在着争议。本研究的目的就是探讨影响cNO舌活动部鳞癌预后的因素并划分高危人群。方法：收集中山大学肿瘤防治中心1990年1月至1998年3月收治的cNO舌活动部鳞癌患者109例的临床资料,应用Cox多因素回归模型（Cox regression model,Cox模型）分析预后影响因素并计算预后指数（prognostic index,PI）,依据个体化的PI,可将患者分为不同的危险组。结果：患者3年和5年的生存率分别为74．40％和69．31％。多因素分析结果显示cNO舌鳞癌患者的T分期、原发灶治疗方式、组织学分化、年龄和隐匿性颈淋巴转移对预后的影响有统计学意义（P＜0．05）,T分期是影响预后的最主要因素。原发灶综合治疗组优于单纯手术和单纯放疗或者化疗组;老年组、低分化组或者伴有隐匿性颈淋巴结转移组的患者预后较差。根据PI值将患者划分为高危组、中危组和低危组,3组的预后两两之间存在统计学差异（P＜0．05）,3组患者5年生存率分别是83．33％、64．12％和27．65％。结论：T分期、原发灶治疗方式、组织学分化、年龄和隐匿性颈淋巴结转移是影响cNO舌鳞癌预后的主要因素;PI值可用于预测cNO舌鳞癌患者的预后。     

miR-219调控PRKCI表达在舌鳞状细胞癌中作用和机制

目的 探讨PRKCI与miR-219表达的相关性以及对舌鳞状细胞癌的细胞增殖、侵袭和转移的影响。方法 利用双荧光素酶报告基因实验对预测的靶基因进行验证, 用qRT-PCR和Western blot实验检测外源过表达miR-219对舌鳞状细胞癌细胞中转染的PRKCI基因和蛋白表达的影响。最后在过表达miR-219的稳转细胞系中再过表达PRKCI, 利用MTT法、细胞平板克隆实验、划痕实验和Transwell小室法分析PRKCI对miR-219抑制舌鳞状细胞癌细胞增殖、克隆形成能力、迁移能力和侵袭能力的逆转效果。通过qRT-PCR法检测舌鳞状细胞癌组织中PRKCI基因的表达情况并进一步分析PRKCI和miR-219之间的关系。结果 通过生物信息学分析预测得到miR-219下游靶基因为PRKCI。双荧光素酶报告基因实验结果显示miR-219能够降低野生型PRKCI报告基因载体的荧光活性。此外qRT-PCR实验和Western blot实验也显示miR-219能够下调PRKCI在舌鳞状细胞癌细胞中的表达。MTT结果显示过表达PRKCI能够逆转miR-219对舌鳞状细胞癌细胞增殖活性的抑制效应, 进一步通过细胞平板克隆实验、划痕实验以及Transwell实验证明PRKCI过表达能够逆转miR-219对TSCC细胞增殖、侵袭和转移的抑制效应。结论 miR-219通过直接靶向PRKCI、负调控PRKCI的表达发挥抑制肿瘤的作用。在舌鳞状细胞癌组织中, miR-219与PRKCI的表达呈负相关。     

Breast metastases from a floor of the mouth carcinoma

Metastases to the breast from extramammary tumours are uncommon and metastatis of floor of the mouth carcinoma to the breast is extremely rare. The clinical outcome of these patients remains dismal. We report the case of breast metastases from a floor of the mouth carcinoma successfully treated by conservative surgery and adjuvant radiotherapy with no demonstrable metastases 33 months after the initial diagnosis.     

口腔鳞癌颈淋巴结转移的临床病理学特点及其对预后的影响

背景与目的口腔癌淋巴结转移率在50%～59%之间,对其处理好坏关系到患者的预后。本研究拟探讨影响口腔鳞癌颈淋巴结转移的临床病理因素及其对预后的影响。方法对191例口腔鳞癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究,并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域、转移颈淋巴结最低受累区域等淋巴结病理学因素对预后生存的影响进行Cox回归分析。结果口腔鳞癌患者5年生存率为48.7%。χ2分析显示,仅肿瘤浸润深度与发生颈淋巴结转移有关。Cox回归分析表明,临床N分期、颈淋巴结转移状态、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域因素影响患者预后,特别是临床N分期、转移颈淋巴结最低受累区域因素与口腔鳞癌患者预后明显相关。结论口腔鳞癌颈淋巴结转移是影响患者预后的重要因素,了解其颈淋巴结转移的规律,并对影响预后的淋巴结因素采取相应治疗措施,对提高口腔鳞癌治疗效果具有重要意义。     

舌体鳞癌隐匿性颈淋巴结转移的外科治疗探讨

背景与目的:对于临床颈淋巴结阴性(cN0)的舌癌颈部的处理一直存在争议,本研究旨在探讨cN0舌体鳞癌颈部的合理治疗方案。方法:回顾性分析187例手术前后未行放、化疗的cN0舌体鳞癌初诊患者的临床资料;分析颈部隐匿性淋巴结转移规律和隐匿性淋巴结转移及预后的影响因素,以及颈部不同处理方式的控制情况。结果:隐匿性淋巴结转移率为23.0%,其最常见的位置在同侧颈Ⅱ区,83.0%的隐匿性淋巴结转移分布在同侧颈Ⅰ、Ⅱ、Ⅲ区;病理分级是影响隐匿性淋巴结转移的独立因素;隐匿性淋巴结转移为影响cN0舌癌患者预后的独立因素;肩胛舌骨肌上清扫术的颈部复发率为6.7%。结论:肩胛舌骨肌上颈清扫术是cN0舌体鳞癌患者有效而安全的治疗措施。     

钆血卟啉单甲醚介导的光动力疗法治疗口腔舌鳞状细胞癌移植瘤的实验研究

目的:探讨钆血卟啉单甲醚（gadolinium coordinated hemetoporphyrin monomethyl ether,Gd-HMME）介导的光动力疗法（photodynamic therapy,PDT）对裸鼠口腔舌鳞状细胞癌（oral tongue squamous cell carcinoma,OTSCC）移植瘤的治疗效果,为今后的临床治疗提供理论依据。方法:选取36只BALB/c-nu裸鼠随机分为4组,分别为对照组、PDT组、Gd-HMME组和Gd-HMME-PDT组,每组9只。治疗后定期测量裸鼠体重以及肿瘤体积,14 d后各组随机处死裸鼠6只,计算抑瘤率和生命延长率,行苏木精-伊红（hematoxylin-eosin staining,HE）染色后病理形态学观察,评估Gd-HMME-PDT对移植瘤的治疗效果。结果:实验结果显示,各处理组的肿瘤体积均小于对照组,Gd-HMME-PDT组肿瘤体积减小最明显（P＜0.01）;PDT组、Gd-HMME组、Gd-HMME-PDT组的抑瘤率分别为3.17%、6.13%、59.62%。HE染色可见Gd-HMME-PDT组肿瘤细胞坏死和空泡性变,对照组及PDT组、Gd-HMME组均未见明显改变;PDT组、Gd-HMME组、Gd-HMME-PDT组的生命延长率分别为2.82%、7.04%、73.24%。结论:Gd-HMME-PDT对口腔舌鳞状细胞癌移植瘤的生长具有抑制作用,并且可以延长裸鼠的生存时间。     

Metastasis of squamous cell carcinoma of the oral tongue

Squamous cell carcinoma of the oral tongue (SCCOT) is one of the most prevalent tumors of the head and neck region. Despite advances in treatment, the survival of patients with SCCOT has not significantly improved over the past several decades. Most frequently, treatment failure takes the form of local and regional recurrences, but as disease control in these areas improves, SCCOT treatment failures are occurring more often as distant metastasis. The presence of cervical lymph node metastasis is the most reliable adverse prognostic factor in patients with SCCOT, and extracapsular spread (ECS) of cervical lymph nodes metastasis is a particularly reliable predictor of regional and distant recurrence and death from disease. Decisions regarding the elective and therapeutic management of cervical lymph node metastases are made mainly on clinical grounds as we cannot always predict cervical lymph node metastasis from the size and extent of invasion of the primary tumors. Therefore, the treatment of these metastases in the management of SCCOT remains controversial. The promise of basing treatment decisions on biomarkers has yet to be fully realized because of our poor understanding of the mechanisms of regional and distant metastases of SCCOT. Here we summarize the current status of investigations of SCCOT metastases and the potential of these studies to have a positive impact on the clinical management of SCCOT in the future.     

舌鳞状细胞癌的第二原发癌

目的评价口腔舌鳞状细胞癌中第二原发癌的发生及预后.方法回顾性分析1975～2000年329例口腔鳞状细胞癌患者的临床资料,生存患者的最短随诊时间为36个月.结果28例患者发生29个第二原发癌,其发生率为8.5%(28/329),其中包括2个同时第二原发癌(6.9%)、27个异时第二原发癌(93.1%).自舌癌确诊到异时第二原发癌确诊的平均时间为101(17～266)个月.23(79%)个第二原发癌发生于上气消化道,而食管是最常见的发生部位.发生于Ⅰ期病变9(11.8%)例、Ⅱ期病变10(10.8%)例、Ⅲ期病变9(6.7%)例,无一例发生于Ⅳ期病变,在临床分期之间,第二原发癌的发生率无明显区别.发生于T1病变11(13.4%)例、T2病变17(8.9%)例,无一例发生于T3和T4病变,在T1和T2病变间,第二原发癌的发生率无明显区别.在随诊期间,9例患者生存,19例患者死亡,其中死于第二原发癌14例.结论口腔舌鳞状细胞癌的第二原发癌并非不常见,食管为最常见的发生部位.第二原发癌易于发生在舌癌的早期病变,其预后较差.     

95例Ⅰ期舌体鳞癌的颈部处理

背景与目的颈淋巴结的转移与复发是舌癌治疗失败的常见原因,目前对早期舌癌的颈部处理仍有争论,本研究旨在探讨选择性颈清扫术在治疗临床Ⅰ期舌体鳞癌中的作用。方法回顾性分析1988年至1997年间手术治疗的95例临床Ⅰ期舌体鳞癌患者,分为颈部观察和选择性颈清扫两组,总结分析选择性颈清扫对颈部复发率、总体生存率等治疗结果的影响。结果行颈部观察组24例,颈部复发率为25.0%(6/24),由于颈部复发而导致的死亡率为20.8%(5/24);行选择性颈清扫组71例,颈部复发率和由于颈部复发而导致的死亡率分别为7.0%(5/71)和4.2%(3/71)。两组的颈部复发率和由于颈部复发而导致的死亡率差异均有显著性(χ2检验,P<0.05);选择性颈清扫组的总体生存率亦显著高于颈部观察组(log鄄rank检验,P<0.05)。结论对临床Ⅰ期舌体鳞癌行选择性颈清扫不但可以提高患者的颈部控制率,而且能减少因颈部复发导致的死亡率,提高患者的总体生存率。     

A preloaded,custom-designed implantation device for stage T1-T2 carcinoma of the floor of mouth

Implantation using rigid interstitial needles is an excellent treatment for small carcinomas that are confined to the anterior floor of mouth, it provides a high rate of local control. However, the needles must be inserted through the non-involved tongue in order to stabilize needle position. Even the most experienced operator has difficulty performing an implant which maintains proper spacing, and some inhomogeneity must be expected. Bone complications are experienced frequently even with early lesions, and the anterior one-third of the tongue is irradiated needlessly.Thirteen patients have received implants with an individually custom designed aluminum holder which holds the needles in a fixed position. Homogeneity of dose is improved, and the location of needles relative to the gingiva can be tailored to the lesion. It is not necessary to pierce the tongue. Operative trauma is minimized, and patient discomfort is less than with former techniques. The entire implant is completed in an instant with minimal exposure. Details of design and construction are presented.