口腔黏膜鳞癌术后复发挽救性再手术的近期疗效观察

目的：观察不同分期复发性口腔黏膜鳞癌挽救性外科再手术的近期疗效。方法：对47例复发性口腔黏膜鳞癌患者临床再分期后实行挽救性外科再切除手术,并对受试者的复发因素进行分析讨论并跟踪随访。结果：复发性口腔黏膜鳞癌的复发早期组的总生存时间和无瘤生存时间以及1年生存率和1年无瘤生存率要明显长于复发进展期组,而复发早期组的术后复发率低于复发进展期组。结论：在临床再分期的基础上实行挽救性外科再切除手术是治疗复发性口腔黏膜鳞癌的首选方法。术后复发的因素集中于肿瘤部位、手术方法、输血和激素的应用等。为减少复发,应注意少输血和尽早撤离激素。     

18例侵犯颈动脉的复发性口腔、口咽鳞状细胞癌的挽救性手术治疗效果评价

目的：评估晚期口腔及口咽鳞状细胞癌（squamous cell carcinoma,简称鳞癌）的挽救性手术及颈动脉处理的效果。方法：对18例侵犯颈总动脉的复发晚期口腔鳞癌及口咽鳞癌的患者行挽救性手术治疗,包括复发灶扩大切除术、颈总动脉结扎术、颈总动脉重建术、颈总动脉解剖术、颈总动脉包裹术,并用复合组织皮瓣修复组织缺损。结果：1例患者术后暂时性偏瘫,2例患者受区创口开裂,2例患者颈动脉爆裂,1例颈总动脉重建患者术后发生颈动脉栓塞。随访5~42个月,12例无复发,2例带瘤生存,4例死于局部复发或远处转移。结论：挽救性手术可有效治疗侵犯颈总动脉的复发晚期口腔鳞癌和口咽鳞癌。根据术前评估处理受肿瘤累及的颈动脉,术式包括颈总动脉结扎术、颈总动脉重建术、颈总动脉解剖术、颈总动脉包裹术。     

原发性腮腺鳞状细胞癌的临床分析

目的回顾性总结分析19例原发性腮腺鳞癌的临床特点、预后的相关因素及治疗策略。方法总结分析1993年3月至2004年2月间收治并经组织病理学证实的原发性腮腺鳞癌19例的临床资料,采用Fisher确切概率法进行分析。结果全组患者在病程中出现颈淋巴转移的概率为68.42%（13/19）,全组3、5年生存率为47.36%和42.10%,无瘤生存7例,带瘤生存1例。术后随访的死亡者中,局部复发6例,颈淋巴转移复发2例,合并有局部复发和颈转移2例,远处肺转移1例。单因素分析仅显示N分期对生存率有影响;而T分期、手术范围、术后病理和是否有血管神经侵犯等对生存率的影响没有统计学意义,究其原因推测与样本含量较小有关。结论原发性腮腺鳞癌的局部复发率和颈淋巴转移率均很高,应用广泛性手术及术后放射治疗是首选的最佳综合治疗方案。     

口腔黏膜鳞癌术后复发相关因素的观察和研究

目的：分析影响口腔鳞癌预后及复发的临床病理因素,为进行综合治疗及其预后评价提供临床依据。方法：对407例原发口腔鳞癌患者以病变部位、肿瘤厚度、临床T分期、区域淋巴结转移、治疗方式、手术方式、术后组织学分级等指标研究与口腔鳞癌术后及复发相关的因素。结果：口腔鳞癌术后的复发率与病变部位、肿瘤厚度、临床T分期、区域淋巴结转移及组织学分级等因素有关,诱导化疗联合手术的综合治疗可有效降低口腔鳞癌的复发率。结论：临床工作中,我们应综合分析各种临床病理因素,对与术后复发关系较为密切的因素进行仔细评估,制定出有效的预防措施,提高口腔鳞癌的手术治愈率及生存率,降低复发率。     

6 舌癌与其他部位口腔癌患者的生存率是否不同？

口腔鳞癌治疗技术的发展，使依照发病部位判断患者预后变得愈加闲惑。该文旨在回顾口腔鳞癌患者的治疗效果．并确定发病部位是否为患者生存率或无瘤生存率的预后因素。方法：对1993～2003年间233例手术切除的OSCC患者进行回顾性研究，将病例分为2组，舌癌73例，其他部位152例，应用Cox模型对2组的生存率进行比较。对切缘阳性、低分化、侵袭性和晚期患者术后辅助放疗或放化疗。对患者的人口统计学资料、发病部位、肿瘤分期、病理学特点、治疗方法及生存资料进行记录，并应用描述性及Kaplan—Meier曲线进行分析，以确定肿瘤局部控制率和患者无瘤生存率的预后因素。     

晚期口腔鳞癌患者独立预后因素及生存预测模型的建立

目的 探讨晚期口腔鳞癌患者的独立预后因素并构建生存预测模型。方法 收集117例晚期口腔鳞癌患者的一般资料及既往病史,所有患者均行口腔鳞癌切除术并联合放疗,根据患者情况进行羟基喜树碱及平阳霉素化疗。所有患者随访时间为手术结束至术后5年,记录患者生存情况,分析晚期口腔鳞癌患者预后的独立危险因素。采用SPSS 20.0软件包对数据进行统计学分析。结果 随访期间,2例因其他原因死亡,4例因失访而剔除。剩余111例患者中, 42例死亡,69例存活,生存率为62.16%;年龄、T分期及M分期不同的晚期口腔鳞癌患者生存情况无显著差异（P>0.05）;性别、组织分化程度、N分期及化疗情况不同的晚期口腔鳞癌患者生存情况差异显著（P<0.05）;性别、N分期及是否联合羟基喜树碱与平阳霉素化疗是晚期口腔鳞癌患者生存情况的独立危险因素（P<0.05）;组织分化程度不是晚期口腔鳞癌患者生存情况的独立危险因素（P>0.05）;性别、N分期及是否联合羟基喜树碱与平阳霉素化疗的生存曲线对晚期口腔鳞癌患者生存情况具有一定预测作用。结论 性别、N分期及是否联合羟基喜树碱与平阳霉素化疗是晚期口腔鳞癌患者生存情况的独立危险因素;性别、N分期及是否联合羟基喜树碱与平阳霉素化疗的生存曲线,可作为晚期口腔鳞癌患者的生存预测模型。     

EGFR在局部晚期口腔鳞癌中的表达及与TPF诱导化疗的关系

目的:探讨EGFR在晚期口腔鳞癌患者中的表达及与TPF诱导化疗的关系。方法:以256例局部晚期口腔鳞癌的前瞻性临床随机对照试验患者为研究对象,采用免疫组织化学方法,检测口腔鳞癌治疗前组织中EGFR的表达情况,分析其与临床病理各项指标的关系。采用SPSS 18.0软件包对数据进行统计学分析。结果:EGFR阳性表达强度与患者的年龄显著相关(P=0.015),未发现其与患者其他临床病理指标之间的显著相关性;在病理和临床疗效方面,EGFR阳性表达强度与TPF诱导化疗疗效无显著相关性。EGFR表达与口腔鳞癌患者的预后无显著相关,包括肿瘤复发、总体生存率、无瘤生存率、无肿瘤复发生存率和无肿瘤转移率。结论:EGFR的表达强度与患者的年龄相关,其在口腔鳞癌中的临床应用价值有待进一步研究。     

63例涎腺腺样囊性癌患者预后相关因素的Cox模型分析

目的 探讨影响涎腺腺样囊性癌(adenoid cystic carcinoma,ACC)患者术后生存的相关因素。方法 回顾性分析1988年1月—2005年10月在我院手术治疗并经病理确诊的63例涎腺ACC患者临床资料,对可能影响患者术后生存的指标进行Kaplan-Meier检验后,采用Cox比例风险回归模型进行多因素分析。结果 63例涎腺ACC患者术后3、5、10年的总生存率分别为77.64%、68.31%、39.26%,无瘤生存率分别为65.73%、57.17%、38.92%。Cox比例风险回归模型多因素分析结果显示:TNM分期、病理类型、神经侵犯、手术方式、放/化疗、局部复发及远处转移是影响患者术后生存的重要因素。结论 高TNM分期、实性病理类型、神经周围侵犯、有局部复发及远处转移等是涎腺ACC患者术后生存的危险因素,能缩短术后生存时间;手术加放/化疗是保护因素。?     

淋巴结外扩展对口腔鳞癌患者TNM分期及生存预后的影响

目的 ：通过分析淋巴结外扩展（extranodal extension, ENE）指标纳入到肿瘤分期后对口腔鳞癌患者TNM分期变化及生存的影响,了解ENE对口腔鳞癌治疗决策及预后评估的意义。方法：回顾分析2014年1月—2017年6月青岛大学附属医院接受手术治疗的485例原发口腔鳞癌（OSCC）患者,对所有患者按AJCC第7版与AJCC第8版TNM分期标准分别进行N分期、TNM分期,采用SPSS 26.0软件包处理数据,以Kaplan-Meier法绘制患者总体生存率（overall survival, OS）和疾病别生存率（disease-specific survival, DSS）的生存曲线,并进行Log-rank检验,使用C指数和AIC评价预测性能。结果：485例OSCC患者中,69例ENE阳性患者（14.43%）发生pN分期改变（pN2a期16例、pN3b期53例）,67例ENE阳性患者（13.81%）发生pTNM改变（ⅣA期14例,ⅣB期53例）。N分期、TNM分期与ENE相关的患者,OS和DSS生存模型分析显示,ENE阳性患者生存率（OS:27.1%,DSS:31.2%）显...     

基于基线期dNLR水平对局部晚期口腔鳞癌患者生存的预后预测—10年临床回顾

目的：探讨基线期中性粒细胞与淋巴细胞比率（derived neutrophils to lymphocyte ratio, dNLR）预测局部晚期口腔鳞癌患者生存预后的价值。方法：纳入临床试验项目（NCT01542931）中接受标准治疗的局部晚期口腔鳞癌患者的基线数据和10年长期随访数据。通过绘制受试者工作曲线及计算曲线下面积,以约登指数确定预后最好时dNLR的截断值,并以此值将所纳入患者分为高dNLR组和低dNLR组,以Kaplan-Meier生存分析和单因素、多因素Cox比例风险模型,比较2组患者的生存差异和风险因素。主要结局指标是总生存时间（overall survival, OS）,次要结局指标是无瘤生存时间（disease-free survival, DFS）、无局部复发生存时间（local recurrence-free survival, LRFS）和无远处转移生存时间（distant metastasis-free survival, DMFS）。采用SPSS 25.0软件包对数据进行统计学分析。结果：纳入局部晚期口腔鳞癌患者115例,平均年龄（54.5±10.7）岁...     

Extended vertical lower trapezius island myocutaneous flap in reconstruction of oral and maxillofacial defects after salvage surgery for recurrent oral carcinoma.

PURPOSE: The purpose of this study was to explore an effective repair method for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral carcinoma. PATIENTS AND METHODS: Eight patients (6 females and 2 males, mean age, 56.9 years) with recurrent oral squamous cell carcinoma of the tongue (n = 4), oral cavity floor (n = 2), and buccal (n = 2) were treated with salvage surgery, and the oral and maxillofacial soft-tissue defects were reconstructed primarily by extended vertical lower trapezius island myocutaneous flap. RESULTS: No flap failure occurred. The donor sites were closed primarily. There were no disabilities with regard to shoulder motion. Followed up after the operation, the survival period of the patients was 6 to 30 months and the average survival period was 13.1 months. There was 1 recurrent case. All of the patients survived. CONCLUSION: The extended vertical lower trapezius island myocutaneous flap, which is a simple, reliable and large flap, can be preferred as a salvage procedure for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral squamous cell carcinoma.     

Clinical outcomes and prognostic factor analysis after salvage surgery for recurrent squamous cell carcinoma of the oral cavity

The purpose of this study was to analyze the oncological outcomes and predictive factors for successful curative salvage surgery after recurrent oral cavity squamous cell carcinoma. A retrospective study was conducted involving 73 patients who received surgery-based salvage treatment. The pattern of failure for primary treatment was local failure in 29 patients, regional failure in 29 patients, and loco-regional failure in 15 patients. The 5-year overall, loco-regional failure-free, and disease-free survival rates were 54.8%, 58.9% and 49.3%, respectively. Patients with an advanced initial N stage, previous treatment with combined modality therapy, loco-regional recurrence, advanced recurrent T stage, a disease-free survival of less than 8 months prior to salvage, and recurrence in a previously treated field had a significantly worse prognosis. Given the potential surgical morbidity, salvage surgery should be undertaken after careful consultation with patients who have factors for a poor prognosis.     

延长下斜方肌皮瓣修复复发性口腔癌术后缺损

目的探讨复发性口腔癌手术后口腔颌面部软组织缺损修复的理想方法.方法对6例复发性口腔鳞状细胞癌患者（舌、口底和颊部各2例）手术治疗,缺损区同期用延长下斜方肌岛状肌皮瓣修复.结果全部皮瓣成活,供区创口一期愈合,无肩臂运动功能障碍.经追踪观察,最长存活30个月,最短13个月,平均生存期为22.6个月.结论延长下斜方肌岛状肌皮瓣制作较简单,设计和转移灵活且皮瓣足够大,可作为复发肿瘤手术后大范围软组织缺损的修复材料.     

Ki-67 expression predicts radiosensitivity in oral squamous cell carcinoma

The prognostic relevance of Ki-67 expression in oral squamous cell carcinoma (OSCC) is still controversial. As proliferating cells are more susceptible to ionizing radiation, the authors investigated if a high proliferation rate reflected by Ki-67 expression, predicts radiosensitivity in OSCC patients. In 52 patients with OSCC who received primary surgery followed by radiation therapy, the proliferation rate was assessed by Ki-67 immunhistochemistry and correlated to recurrent free survival and overall survival. Low proliferative carcinomas showed a significantly shorter mean time to recurrence of 27.5 months compared to 49.5 months of high proliferative tumours (p=0.048). The 5-year survival rate of low proliferative tumours was 49% compared to 80% for high proliferative tumours (p=0.042). This study indicates that tumours with high proliferative activity are more susceptible to radiation therapy. Ki-67 might be used as a marker to predict the response to radiation therapy in patients with OSCC.     

Survival in node-positive early oral squamous cell carcinoma: sentinel node biopsy versus elective neck dissection

Patients undergoing sentinel node biopsy (SLNB) for early oral squamous cell carcinoma (OSCC) who harbour occult metastases (pN+ve) may be at greater risk of mortality due to prolonged overall treatment times than those identified as pN+ve on elective neck dissection (ELND). A retrospective comparative survival analysis was therefore undertaken to test this hypothesis. Patients were identified from the South Glasgow multidisciplinary team (MDT) database. Group 1 comprised 38 patients identified as pN+ve, or who were false negative, on sentinel lymph node biopsy (SLNB). Group 2 comprised 146 patients staged pN+ve on ELND. The groups were compared with the Kaplan Meier method and Cox proportional hazards model. In addition, a matched-pair analysis was performed. A unique and specifically designed algorithm was deployed to optimise the pairings. No difference in disease-specific or overall survival was found between the groups. Patients undergoing SLNB as the initial neck staging modality in early OSCC and are identified as pN+ve do not appear to be at a survival disadvantage compared with those staged with ELND.     

Survival and prognostic factors in patients with oral squamous cell carcinoma

Background This study aimed to evaluate sociodemographic and clinical factors influencing overall survival (OS) in patients with oral squamous cell carcinoma (OSCC). Material and Methods Medical charts of 547 patients with OSCC from a public hospital in northeastern Brazil seen between 1999 and 2013 were evaluated. Survival analysis was performed using the Kaplan-Meier method. The influence of age, sex, ethnicity, clinical stage, anatomical location, type of treatment, and comorbidities on the patients’ prognosis was evaluated. Cox proportional hazards regression model was used to identify independent prognostic factors. Results The 5-year OS was 39%. Multivariate analysis showed that age < 40 years (HR = 2.20; 95%CI: 1.02-4.72) and a single treatment modality (HR = 1.91; 95%CI: 1.37-2.67) were associated with a poor prognosis, while early clinical stage resulted in better outcomes (HR = 0.38; 95%CI: 0.25-0.58). Conclusions OSCC patients in advanced clinical stages, diagnosed at a younger age, and submitted to a single therapeutic modality have a poorer prognosis. Key words:Head and neck cancer, oral cancer, oral squamous cell carcinoma, survival, prognosis.     

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.     

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....