3 肿瘤复发间隔时间对口腔鳞癌患者生存率的影响

该文旨在研究肿瘤复发间隔时间对口腔鳞癌患者生存率的影响。方法：对1687例患者进行回顾性研究，应用描述性分析、双变量分析、Kaplan—Meier曲线、Cox模型等统计学方法分析肿瘤复发间隔时间与患者生存率的关系。结果：局部复发率31-3％。Kaplan—Meier曲线分析显示，患者肿瘤复发后的5年生存率为31．56％；Cox模型分析提示18个月内肿瘤复发的患者具有更高的死亡率。结论：口腔鳞癌患者自初治到肿瘤复发的时间间隔，是判断患者预后的独立因素。问隔时间短，提示患者预后差。     

Evaluation of cortical mandibular bone in patients with oral squamous cell carcinoma

Clinical Oral Investigations - The aim of the study was to evaluate the mandible cortical bone changes in patients with oral squamous cell carcinoma (OSCC). Twenty patients who underwent some...     

Evaluation of bone resection margins of segmental mandibulectomy for oral squamous cell carcinoma

Resection margins are frequently studied in patients with oral squamous cell carcinoma and are accepted as a constant prognostic factor. While most evidence is based on soft tissue margins, reported data for bone resection margins are scarce. The aim of this retrospective study was to evaluate and determine the utility of surgical margins in bone resections for oral cavity squamous cell carcinoma (OCSCC). The status of bone resection margins and their impact on survival was investigated in patients who had undergone segmental mandibulectomy for OCSCC. Medical records were retrieved for the years 2000–2012; 127 patients were identified and included in the study. Tumour-positive bone resection margins were found in 21% of the patients. The 5-year overall survival was significantly lower in this group (P < 0.005). Therefore, there is a need for intraoperative feedback on the status of bone resection margins to enable immediate additional resection where necessary. Although the lack of intraoperative methods for the evaluation of bone tissue has been addressed by many authors, there is still no reliable method for widespread use. Future research should focus on an objective, accurate, and rapid method of intraoperative assessment for the entire bone resection margin to optimize patient outcomes.     

Analysis of death certification in patients with early stage oral cavity squamous cell carcinoma.

PURPOSE: Although patients with T1 oral cavity carcinoma have a generally good prognosis, there is a significant burden of patients that have locoregional recurrence and mortality from early stage disease. The aim of this study was to investigate the specific cause of death in patients with T1N0M0 oral cavity squamous cell carcinoma (OCSCC) by analysis of death certification. PATIENTS AND METHODS: Patients were identified with T1 OCSCC treated over a 15-year period between 1986 to 2001 from the Mayo Clinic Tumor Registry. All patients were treated by operation without neck dissection or postoperative neoadjuvant therapy as the initial method of treatment. On detailed examination of the death certificate the leading cause of death was identified along with other clinical predictors of death. RESULTS: Two hundred fifty patients were identified and met inclusion criteria from the Mayo Clinic Tumor Registry. Of the study group, 8.5% and 16% developed local and regional recurrence, respectively, as the first recurrence. The majority of recurrences that were amenable to surgery were managed by radical resection and postoperative neoadjuvant therapy. Of 85 deaths in the study group, 40 death certificates were obtained and reviewed to ascertain a specific cause of death. Patients were grouped into death from oral cancer, other cancer, or medical disease. Primary cause of death from the death certificates available for review included uncontrolled locoregional disease (20%), metastatic oral cancer (15%), development of secondary nonoral malignancy (15%), and a variety of medical causes (50%). Patient age at the time of diagnosis older than 65 had a statistically significant increase in mortality. Interestingly, the presence of premorbid medical conditions, history, or persistent tobacco and alcohol use did not seem to be related to overall mortality. CONCLUSION: Early stage OCSCC continues to portend a poor prognosis. Analysis of death certification provides useful information of the specific cause of death.     

Monocyte/macrophage functions in patients with squamous cell carcinoma of the oral cavity

Peripheral blood monocytes and draining lymph node macrophages from patients with squamous cell carcinoma of the oral cavity, monocytes from patients with oral leukoplakia and those from healthy donors were assessed for FcR. HLA-DR expression and interleukin-1 (IL-1) production after activation with LPS or IFN gamma. Monocyte cytotoxicity was also tested after activation with LPS, IFN gamma, IL-2 singly, or in combinations at suboptimal concentrations. The results showed that the percentage of activated monocytes expressing FcR was significantly low in untreated oral cancer patients, however, the proportion of HLA-DR positive cells was normal. The unstimulated monocytes from oral cancer patients showed spontaneous generation of IL-1. Upon activation, few patients could produce IL-1 to normal levels. The unstimulated monocytes from untreated patients and treated patients with recurrence also exhibit significantly higher tumoricidal activity. Treatment of monocytes with combinations of two modulators (IFN gamma, LPS and IL-2) induced significantly higher cytotoxicity.     

Factors that influence the method of mandibular resection in the management of oral squamous cell carcinoma

The method of conservative (rim) resection of the mandible is now well established and provides good control of disease in the primary site. There are few audits of this technique in terms of margins of resection for both rim and segmental resection of the mandible. Consecutive previously untreated patients managed with resection of the mandible as part of their treatment for oral and oropharyngeal squamous cell carcinoma were recruited for the study. The presence and extent of tumour invasion of the mandible was recorded and a retrospective analysis made to establish the incidence of unnecessary segmental resections. The invasion rate was 33% (8/35) for rims and 83% (54/65) in segmental resections of the mandible, which compares favourably with previous studies and indicates a reasonable accuracy of resection. In between 6 and 11 of the 62 cases (10-17%) a rim resection could have achieved a satisfactory resection margin and retained a functioning lower border of the mandible. The accuracy of resection in terms of margins was greater for mandibular resections (94% clear margins) than soft tissues (62% clear margins). The number of compromised margins was significantly greater in the invaded rim resection group (P=0.018). This study indicates that a more conservative mandibular resection was possible in a few cases. This is unlikely to have an adverse effect on the close or involved margin rate, which depends mainly on the accuracy of the soft tissue resection. Angling the horizontal rim resection to take into account tumour entry at the point of contact will help to ensure a clear bone margin if a conservative approach to mandibular resection is an option.     

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。     

Neck dissection with the harmonic scalpel in patients with squamous cell carcinoma of the oral cavity

Our purpose was to evaluate the use of the Harmonic scalpel in neck dissections.Material and methodsWe conducted a randomized prospective intervention study to compare the Harmonic scalpel (32 patients) with the conventional technique (31 patients).ResultsOperative time was lowered by 64 min (p < 0.001) and 7.5 min (p = 0.367); blood lost during surgery was lowered by 80.5 ml (p < 0.001) and 76.6 ml (p < 0.001); the length of time the drains were kept in place was lowered by 1.3 days (p < 0.001) and 1.5 days (p < 0.01); and the volume of drainage was lower by 228.7 ml (p < 0.001) and 187.6 ml (p < 0.01) in selective and comprehensive neck dissections respectively in patients treated with the Harmonic scalpel.ConclusionsThe Harmonic scalpel shortens operative time in selective dissections. It reduces blood loss during surgery; time drains are kept in place and the amount of drainage in comprehensive and selective neck dissections.     

Removal of an oral squamous cell carcinoma including parts of osseointegrated implants in the marginal mandibulectomy. A case report

Purpose

The incidence of oral squamous cell carcinomas (OSCC) arising around dental implants will increase because of the rising popularity of dental implants. In this case, a novel surgical treatment of an OSCC in the vicinity of endosseous implants is reported.

Materials and methods

In a 69-year-old woman, a recurrent OSCC (cT₂N₀M₀) developed in the floor of the mouth extending to the attached keratinized peri-implant mucosa of both interforaminal-placed dental implants. Radiographically, no bone invasion could be observed.

Results

To radically remove the tumor, a marginal mandibulectomy was performed including the cranial parts of both dental implants by cutting them into two parts. Three years after tumor resection and one year after reimplantation, the patient is disease free and has a good oral function.

Conclusions

In case of an OSCC, traditional bone and soft margins for oncologic safety are 1.0 cm. If a dental implant is present within this safety zone, on condition, there is no massive bone invasion, and the original mandible has sufficient vertical height; a marginal mandibulectomy including part of the implants can be considered.     

Karyotypic abnormalities of squamous cell carcinoma of the oral cavity

The karyotypic abnormalities in 18 squamous cell carcinomas of the oral cavity were studied in unhanded chromosomes on direct preparations of the tumor material. The chromosome counts revealed a great variability in the number of chromosomes per cell of each tumor, the range being from 31 to 148 in all cases studied. The modal population of cells was diploid in five cases, triploid in eight cases, tetraploid and pentaploid in one case each. Reduction of the number of chromosomes was more consistently observed in groups A and B, frequently involving chromosome No 1 and increases in groups C, D, E, F and G. Markers were frequently present, the most common being an almost metacentric chromosome of the size of the chromosomes of Group C.     

Hypercalcemia in patients with oral squamous cell carcinoma

Humoral hypercalcemia of malignancy (HHM) is one of the most common metabolic complications associated with cancer. A retrospective study of hypercalcemia in patients with squamous cell carcinoma of the oral cavity was undertaken. All patients were periodically monitored for their serum level of calcium (Ca). Hypercalcemia was defined as a serum Ca concentration higher than 11 mg/dl of the correction for serum albumin concentration. The serum levels of parathyroid hormone related protein (PTH-rP) were also measured by radioimmunoassay. Hypercalcemia was detected in ten of 246 patients (4.1%). All ten patients were at an advanced stage of oral squamous cell carcinoma (SCC, Stage IVA, IVB or IVC). In these ten patients, the serum level of PTH-rP was significantly elevated, 238 +/- 91 pmol/l (range, 108-380 pmol/L). The patients with HHM who underwent antihypercalcemic therapy showed reduced Ca levels relating to PTH-rP levels; however, the Ca concentration was temporarily improved after anti-hypercalcemic treatment. The median survival time after diagnosis of HHM was only 55.8 +/- 19.9 days (range, 27-86 days). HHM in oral cancer is likely attributable to PTH-rP, and its occurrence appears to be an ominous prognostic sign.     

Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients

Our aim was to examine the clinicopathological features of squamous cell carcinoma (SCC) of the oral cavity and oropharynx in a group of young patients who were dignosed during a 15-year period (2000–2014). Patients’ clinical details, risk factors, and survival were obtained from medical records. Formalin-fixed, paraffin-embedded, tissue was tested for high-risk human papillomavirus (HPV). The results were compared with those of a matching group of older patients. We identified 91 patients who were younger than 45 years old, and the 50 youngest patients were studied in detail. The male:female ratio was 2:1, with more tumours located in the oral cavity than in the oropharynx (35 compared with 15). HPV-related SCC was restricted to the oropharynx. When matched for site, stage and HPV status, five-year overall survival was similar in young and matched older patients (log-rank test, p = 0.515). Our findings suggest that young patients with oral SCC have a disease profile similar to that of older patients with the condition. It is plausible that prognostic information generally available for oral cancers is applicable to young patients with the disease.     

Karyotypic abnormalities of squamous cell carcinoma of the oral cavity

The karyotypic abnormalities in 18 squamous cell carcinomas of the oral cavity were studied in unbanded chromosomes on direct preparations of the tumor material. The chromosome counts revealed a great variability in the number of chromosomes per cell of each tumor, the range being from 31 to 148 in all cases studied. The modal population of cells was diploid in five cases, triploid in eight cases, tetraploid and pentaploid in one case each. Reduction of the number of chromosomes was more consistently observed in groups A and B, frequently involving chromosome No 1 and increases in groups C, D, E, F and G. Markers were frequently present, the most common being an almost metacentric chromosome of the size of the chromosomes of Group C.     

Effects of melatonin receptor expression on prognosis and survival in oral squamous cell carcinoma patients

Melatonin receptors can inhibit breast and prostate cancers; however, little is known regarding their effects on oral squamous cell carcinoma. In this study, we collected specimens from 81 patients with oral squamous cell carcinoma and analysed clinicopathological data retrospectively. In addition, the expression of the melatonin receptor was analysed immunohistochemically. Survival rates were calculated using the Kaplan–Meier method and log-rank test. Multivariate analysis was performed based on the Cox proportional-hazards model. Further, an in vitro study was performed using YD15 cells. The cells were transfected with siRNA targeting melatonin receptor 1A and 1B for evaluating the malignancy of melatonin receptors by western blotting, trypan blue-exclusion, colony-forming, wound-healing, and invasion assays. Survival decreased as melatonin receptor expression and clinical and pathological tumour–node–metastasis stages increased. A Cox proportional-hazard model showed that melatonin receptor 1A may serve as a significant predictor of the survival rate of patients with oral squamous cell carcinoma [hazard ratio = 1.423, 95% confidence interval (CI) = 1.019–1.988, p = 0.038]. Melatonin receptor 1A and 1B knockdown significantly suppressed proliferation, migration ability, and invasion ability of YD15 cells in vitro. Our findings reveal that inhibiting melatonin receptor expression may suppress oral squamous cell carcinoma development.     

Registration of magnetic resonance and computed tomography images in patients with oral squamous cell carcinoma for three-dimensional virtual planning of mandibular resection and reconstruction

The aim of this study was to evaluate and present an automated method for registration of magnetic resonance imaging (MRI) and computed tomography (CT) or cone beam CT (CBCT) images of the mandibular region for patients with oral squamous cell carcinoma (OSCC). Registered MRI and (CB)CT could facilitate the three-dimensional virtual planning of surgical guides employed for resection and reconstruction in patients with OSCC with mandibular invasion. MRI and (CB)CT images were collected retrospectively from 19 patients. MRI images were aligned with (CB)CT images employing a rigid registration approach (stage 1), a rigid registration approach using a mandibular mask (stage 2), and two non-rigid registration approaches (stage 3). Registration accuracy was quantified by the mean target registration error (mTRE), calculated over a set of landmarks annotated by two observers. Stage 2 achieved the best registration result, with an mTRE of 2.5 ± 0.7 mm, which was comparable to the inter- and intra-observer variabilities of landmark placement in MRI. Stage 2 was significantly better aligned compared to all approaches in stage 3. In conclusion, this study demonstrated that rigid registration with the use of a mask is an appropriate image registration method for aligning MRI and (CB)CT images of the mandibular region in patients with OSCC.