Early stage squamous cell cancer of the oral tongue--clinicopathologic features affecting outcome

BACKGROUND:

The objective of this study was to report the authors' experience in the management of patients with early stage squamous cell cancer (SCC) of the oral tongue and determine clinicopathologic factors predictive of outcome.

METHODS:

Two hundred sixteen patients with early stage (cT1T2N0) SCC of the oral tongue were identified from a pre‐existing database of patients with oral cancer who were treated at Memorial Sloan‐Kettering Cancer Center from 1985 to 2005. Patient, tumor, and treatment characteristics were recorded. Overall survival (OS), disease‐specific survival (DSS), and recurrence free survival (RFS) were calculated using the Kaplan‐Meier method. Predictors of outcome were identified using multivariate analysis.

RESULTS:

With a median follow‐up of 80 months (range, 1‐186 months), the 5‐year DSS, OS, and RFS rates were 86%, 79%,and 70%, respectively. Local, neck, and distant recurrences occurred in 24 patients (11%), 40 patients (18%), and 5 patients (2%), respectively. Multivariate analysis identified occult neck metastases as the main independent predictor of OS, DSS, and RFS; patients who had occult metastases had a 5‐fold increased risk of dying of disease compared with patients who did not have occult metastases (5‐year DSS, 85.5% vs 48.5%; P = .001). A positive surgical margin was the main independent predictor for local RFS (91% vs 66% for a negative surgical margin; P = .0004), and depth of invasion was the main predictor for neck RFS (91% vs 73% for depth of invasion <2 mm and >2 mm, respectively; P = .02).

CONCLUSIONS:

In the authors' experience, patients with early stage oral tongue cancer have excellent outcomes. In the current study, the presence of occult metastases was the main predictor of survival outcome. Cancer 2012;. © 2011 American Cancer Society.     

Neck observation versus elective neck dissection in management of clinical T1/2NO oral squamous cell carcinoma: a retrospective study of 232 patients

Objective:The management of early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC) remains a controversial issue.The aim of this study was to compare the clinical outcomes of neck observation (OBS) and elective neck dissection (END) in treating patients with cT1/2N0OSCC.Methods:A total of 232 patients with cT1/2N0OSCC were included in this retrospective study.Of these patients,181 were treated with END and 51 with OBS.The survival curves of 5-year overall survival (OS),diseasespecific survival (DSS),and recurrence-free survival (RFS) rates were plotted using the Kaplan-Meier method for each group,and compared using the Log-rank test.Results:There was no significant difference in 5-year OS and DSS rates between END and OBS groups (OS:89.0％ vs.88.2％,P=0.906;DSS:92.3％ vs.92.2％,P=0.998).However,the END group had a higher 5-year RFS rate than the OBS group (90.1％ vs.76.5％,P=0.009).Patients with occult metastases in OBS group (7/51) had similar 5-year OS rate (57.1％ vs.64.1％,P=0.839) and DSS rate (71.4％ vs.74.4％,P=0.982) to those in END group (39/181).In the regional recurrence patients,the 5-year O S rate (57.1％ vs.11.1％,P=0.011) and D SS rate (71.4％ vs.22.2％,P=0.022) in OBS group (7/51) were higher than those in END group (9/181).Conclusions:The results indicated that OBS policy could obtain the same 5-year OS and DSS as END.Under close follow-up,OBS policy may be an available treatment option for patients with clinical T1/2N0OSCC.     

Immunohistochemical study on overexpression of cyclooxygenase-2 in squamous cell carcinoma of the oral cavity: its importance as a prognostic predictor

Cyclooxygenase-2 (COX-2) is known as one of the critical prognostic factors in carcinomas of the various organs. However, the importance of COX-2 overexpression in oral squamous cell carcinomas has not been fully described yet. We investigated overexpression of COX-2 by immunohistochemistry in 72 surgical specimens from patients with squamous cell carcinoma of the oral cavity, and evaluated correlations between COX-2 overexpression and clinicopathologic variables. The immunoreactivity of COX-2 was cytoplasmic. COX-2 overexpression was observed in 10 (13.9%) of 72 tumours and it was well correlated with lymph node involvement at the time of surgical treatment (P=0.011) and postoperative recurrence (P=0.025), but not with the other clinicopathologic variables including age, gender, tumour stage and histological grade. In addition, COX-2 overexpression showed a close association with postoperatively disease-free survival (P=0.039) and overall survival as well (P=0.043), and multivariate analyses revealed that COX-2 overexpression was an independent predictor for disease-free survival but not for overall survival. The current study suggests that overexpression of COX-2 could impact on disease-free survival for patients with oral squamous cell carcinoma and that selective inhibition of COX-2 is a possible target for the therapeutic strategies.     

Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer

Squamous cell carcinoma (SCC) of the oral tongue is characterized by a high propensity for cervical nodal metastasis, which affects the probability of regional control and survival. Until now, elective treatment of the clinically negative neck in early lesions (T(1-2)) of the oral tongue cancer remains controversial. This study attempted to identify predictive factor(s) for cervical nodal metastasis and treatment outcomes in patients with early stage SCC of the oral tongue treated primarily by surgery. Fifty patients with previously untreated Stage I/II primary tongue carcinomas with available archival specimens treated at the Royal Marsden Hospital between 1981 and 1998 were reviewed. Clinico-pathological features including age, gender, alcohol and tobacco consumption, tumour location, histological grade, tumour-stromal border, growth pattern, tumour thickness, and clinical stage were evaluated and the correlations with cervical metastases and outcome analysis were determined. The overall occult nodal metastatic rate was 40% (20/50). Tumour thickness exceeding 5 mm was statistically significantly correlated with cervical metastases (P = 0.003; relative risk = 2.429). No statistical correlation was observed between other clinico-pathological parameters and nodal metastasis. With a median follow-up of 98 months, 5-year actuarial overall, disease-specific (DSS), and relapse-free survival were 65.71, 67.77, and 68.18%, respectively. Univariate analysis for DSS showed poorer outcomes for patients with age > 60 years (P = 0.0423) and tumour thickness > 5 mm (P = 0.0067). The effect of tumour thickness was maintained (P = 0.005) on multivariate analysis. The present study indicates that the thickness of primary tumour has a strong predictive value for occult cervical metastasis and poor outcomes in patients with Stage I/II oral tongue SCC. Thus, elective neck treatment (surgery or irradiation) is indicated for tumours exceeding 5 mm thickness.     

Salvage therapy in relapsed squamous cell carcinoma of the oral cavity: How and when?

BACKGROUND: Relapse of tumors in patients with oral cavity squamous cell carcinoma (OSCC) is associated with a poor prognosis. In addition, salvage therapy may be a significant source of morbidity in patients with relapsing OSCC. The objective of the current study was to determine prognostic factors that predict which patients may benefit from such treatment. METHODS: From 953 patients who underwent primary radical surgery between 1996 and 2005, 272 patients with early-relapsed OSCC (n = 161) or late-relapsed OSCC (n = 111) were identified. The optimum cutoff point for relapse was chosen on the basis of 5-year disease-specific survival (DSS) and overall survival (OS). RESULTS: The optimal cutoff value for relapse was 10 months. Late relapses were associated with a better prognosis than relapses that occurred within the first 10 months (P < .0001 for both 5-year DSS and 5-year OS). Among patients with early-relapsed OSCC, a primary tumor depth <10 mm was associated significantly and independently with a better 5-year DSS (P = .014) and OS (P = .011). Among patients with late-relapsed OSCC, neck recurrence was a significant risk factor for adverse outcomes (P < .001 for both 5-year DSS and 5-year OS). CONCLUSIONS: A late relapse was associated with better survival than a relapse that occurred within the first 10 months. Patients with late-relapsed OSCC may benefit from salvage therapy, especially those who have a local recurrence. Among patients with early-relapsed OSCC, salvage therapy should be considered for those who have a primary tumor depth <10 mm.     

Apoptosis index is a predictor of metastatic phenotype in patients with early stage squamous carcinoma of the tongue: a hypothesis to support this paradoxical association

BACKGROUND: Patients with squamous carcinoma of the oral tongue in clinical stages TIN0M0 and T2N0M0 with a tumor thickness < or = 3 mm usually do not have lymph node (LN) metastasis. However, factors that are useful in predicting LN metastasis in thicker tumors (> 3 mm thick) need to be identified. The authors investigated the clinical relevance of the apoptotic index (AI), the proliferation index, and tumor grade in relation to LN metastasis in patients with early stage squamous carcinoma of the oral tongue. METHODS: Twenty-three patients with squamous carcinoma of the anterior two-thirds of the tongue measuring < 2 cm in height and > 3 mm in thickness were evaluated for tumor grade, AI (by using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling technique), and proliferation index (by proliferating cell nuclear antigen [PCNA] expression). RESULTS: The mean AI value was significantly higher in LN positive patients compared with LN negative patients (P = 0.012). The LN positive and LN negative subgroups did not differ in the mean PCNA index, and there was no significant difference in the distributions of tumor grade between LN positive and LN negative subsets. Four of 12 tumors with an AI < or = 5% and 10 of 11 tumors with an AI > 5% had LN metastasis (P = 0.009; risk ratio, 20). The AI maintained its significance with respect to LN metastasis in the multivariate analysis (P = 0.003). The 4-year recurrence free survival was significantly better in patients with tumors that had an AI value < or = 5% compared with patients with tumors that had an AI > 5% (92% vs. 32%) (P = 0.033). However, the AI lost its impact on recurrence free survival within a Cox proportional hazards model (P = 0.068). CONCLUSIONS: A higher AI value is a predictor of LN metastasis and may serve as a prognostic factor in patients with early stage squamous carcinoma of the oral tongue. The authors present a hypothesis to explain this rather surprising finding.     

Expression of 70-kDa heat shock protein in oral lesions: marker of biological stress or pathogenicity

We showed differential expression of HSP70 during oral tumorigenesis. The precise functional role of HSP70 overexpression in the pathogenesis of betel and tobacco related oral cancer remains to be determined. To evaluate the utility of HSP70 as an indicator of the biological stress experienced by tumour cells or the malignant potential of oral epithelial lesions and predicting clinical outcome, its expression was assessed in different stages of oral carcinogenesis by immunohistochemical analysis and correlated with clinicopathological parameters. Overexpression of HSP70 protein was observed in 38 of 64 (59%) dysplastic lesions and 92 of 125 (74%) oral squamous cell carcinomas (SCCs) which included 76 of 105 cases (72%) of primary oral SCCs and 16 of 20 (80%) of recurrent oral SCCs. A significant correlation of HSP70 expression was observed with severity of dysplasia (P=0.0006767), poor histological differentiation of primary tumours (P=0.0184348), increase primary tumour size (P=0.0221103) and consumption of betel and tobacco (P<0.01). Follow-up studies showed that in patients with premalignant lesions the median transition time (premalignancy to malignancy) was significantly shorter in HSP70 overexpressing cases than those showing basal level of HSP70 (P=0.012). Oral cancer patients with elevated levels of HSP70 showed decreased median disease-free survival time (no recurrence/metastasis) than those showing basal HSP70 immunoreactivity (P=0.0246). The results suggest that HSP70 expression may not be a mere marker of biological stress but may also be implicated in the pathogenesis of oral cancer.     

Predictors of outcome in patients undergoing postchemotherapy retroperitoneal lymph node dissection for testicular cancer

BACKGROUND: The management of metastatic nonseminomatous germ cell tumors (NSGCT) frequently consists of systemic chemotherapy followed by retroperitoneal lymph node dissection (PC-RPLND). The aim of the present study was to evaluate the authors' PC-RPLND experience and identify predictors of outcome in these patients. METHODS: Between 1980 and 2003, 236 patients with clinical Stage IIA-III NSGCT underwent PC-RPLND. Their medical records were retrospectively reviewed for pertinent clinical and treatment-related outcomes. The 5-year disease-specific and recurrence-free survival was 85% and 75%, respectively, with the median length of follow-up after RPLND 45 months (6-250 months). RESULTS: The median age of patients at diagnosis was 28 years, with all patients receiving systemic chemotherapy (median of 5 cycles) before RPLND. On multivariate analysis, predictors of poorer disease-specific survival (DSS) included systemic symptoms at presentation (P = .05), elevated pre-RPLND serum alpha fetoprotein (AFP, P = .006) and beta-human chorionic gonadotropin (HCG, P = .004), postoperative complications (P = .03), and recurrence (P < .0001). Predictors of poorer recurrence-free survival (RFS) included advanced clinical stage (IIC-III, P = .001) and presence of viable tumor in the RPLND specimen (P = .03). A pre-RPLND serum AFP > 9 ng/mL and HCG > 4.1 mIU/mL were found to predict a worse DSS (P = .03 and .03, respectively). CONCLUSIONS: In patients undergoing PC-RPLND, preoperative tumor markers and the occurrence of postoperative complications or recurrence are predictive of poorer DSS. Advanced clinical stage and viable tumor in the surgical specimen predict worse RFS.     

Loco-regional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation

Purpose: Potential risk factors including DNA flow cytometric-derived parameters predicting loco-regional recurrence (LRR) in early breast cancer were investigated.

Materials and methods: This study included 608 patients treated by modified radical mastectomy between 1982 and 1987. Recommendations regarding local treatment as well as adjuvant systemic therapy did not change during this period. Patients treated by adjuvant chemotherapy were randomized to receive additional medroxyprogesterone acetate (MPA) treatment. Only 59 (10%) patients received postoperative irradiation (XRT) to the chest wall and/or axillary lymph nodes; another 121 (20%) patients received XRT to the internal mammary nodes because of centromedially located tumours.

Results: Patients were followed for a median period of 7.5 years. The event-free survival at 10 years was 50%. The cumulative incidence rate of LRR at 10 years was 18% (n=93), either with (n=30) or without (n=63) concurrent distant metastases. The chest wall, regional lymph nodes or both were involved in 41 (44%), 38 (41%) and 12 (13%) patients, respectively. Multivariate analysis according to the Cox model revealed two factors associated with LRR, i.e. pT (P<0.05) and nodal status (P<0.05). In node-positive patients extracapsular tumour extension (ECE) and pT were independent risk factors. DNA ploidy and S-phase fraction did not yield additional information. Based on pT, nodal status and extracapsular extension of tumour growth a high risk (>10%) and low risk (<10%) group for LRR could be identified.

Conclusions: Results indicate that T-stage and nodal status, combined with ECE, may help to identify patients at risk for loco-regional recurrence, whereas DNA flow cytometry does not.     

放疗延迟对乳腺癌不同分子亚型患者预后的影响

目的 探讨放疗延迟对乳腺癌不同分子亚型患者预后的影响。方法 收集2007年1月—2012年12月在我院行乳腺癌根治术患者341例,其中Luminal A型149例(对照组83例,放疗延迟组66例),Luminal B型105例(对照组63例,放疗延迟组42例),HER2+型43例(对照组28例,放疗延迟组15例),三阴型患者44例(对照组27例,放疗延迟组17例)分析放疗延迟组与对照组预后是否存在差异。结果 Luminal A型、Luminal B型、HER2+型、三阴性型在对照组和放疗延迟组的局部复发率分别为(4.8% vs. 9.1%,P=0.301),(4.7% vs. 19.0%,P=0.019),(7.1% vs. 33.3%,P=0.027),(11.1% vs. 35.3%,P=0.053);远处转移率分别为(9.6% vs. 10.6%,P=0.845),(11.1% vs. 14.2%.P=0.234),(32.1% vs. 40.0%,P=0.937),(37.0% vs. 41.2%,P=0.784);无瘤生存率分别为(85.5% vs. 80.3%,P=0.395),(84.1% vs. 66.7%,P=0.037),(60.7% vs. 33.3%,P=0.087),(55.5% vs. 23.5%,P=0.037);总生存率分别为(94.0% vs. 90.9%,P=0.539),(84.1% vs. 80.9%,P=0.672),(67.9% vs. 60.0%,P=0.606),(59.2% vs. 41.2%,P=0.242)。Cox回归分析结果显示肿瘤大小(HR=3.156,P=0.043)、淋巴结转移(HR=1.074,P=0.001)、TNM(HR=8.591,P=0.009)和分子亚型(HR=2.092,P＜0.001)为乳腺癌患者预后的独立影响因素。结论 Luminal B型及HER2+型患者的局部复发率均因放疗延迟而明显增高,Luminal B型及三阴型的无瘤生存率因放疗延迟而明显降低。肿瘤大小、淋巴结转移、TNM分期和分子亚型是影响患者总生存期的独立危险因素。     

术前炎症相关指标与可切除胃癌患者预后的相关性

目的 探讨术前外周血系统性免疫炎症指数(Systemic immune-inflammation index,SII)、中性粒细胞与淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(Platelet to lymphocyte radio,PLR)与可切除胃癌患者预后的相关性及其临床意义。方法 回顾性分析2013年10月—2015年2月哈尔滨医科大学附属肿瘤医院收治的226例经手术治疗胃癌患者的临床病理资料。评估并比较SII、NLR、PLR在可切除胃癌患者中的预后价值。结果 胃癌组SII、NLR、PLR显著高于健康对照组,差异均有统计学意义(P＜0.05)。多因素Cox回归分析结果显示SII高(HR=2.947,95% CI:1.345~6.454,P=0.007)、NLR高(HR=2.876,95% CI:1.445~5.724,P=0.003)、T分期越高(HR=5.885,95% CI:1.641~21.099,P=0.007)、有远处转移(HR=3.010,95% CI:1.472~6.154,P=0.003)是影响可切除胃癌患者预后的独立危险因素。SII预测可切除胃癌患者结局的ROC曲线下面积为0.840,灵敏度为86.6%,特异度为68.0%,高于NLR、PLR及CA199,且差异有统计学意义(P＜0.05)。结论 SII对可切除胃癌患者生存结局的评估价值优于NLR和PLR。     

Elective neck treatment versus observation in patients with T1/T2 N0 squamous cell carcinoma of oral tongue

A retrospective analysis of 80 patients treated for T1/T2 N0 squamous cell carcinoma of oral tongue was performed. The patients were divided into two groups according to the management of the neck: those without (n = 34) and those with elective neck treatment (n = 46). The two groups were compared with respect to overall survival (OS), disease specific survival (DSS), and recurrences. The incidence of occult nodal disease and the results of salvage treatment were analysed. There were significantly fewer regional recurrences in patients with elective neck treatment. Statistical differences in OS or DSS between the treatment groups were not found. Of all the patients with locoregional recurrence, 33% were salvaged. The incidences of occult metastasis for T1 and T2 tumours were 24% and 35%, respectively. The elective neck treatment resulted in better regional control. The results of salvage treatment were poor. The risk for occult cervical metastasis is high in patients with early tongue tumours and only carefully selected patients can be left without prophylactic neck treatment.     

GAB2在卵巢癌组织中的表达及其与预后的相关性

目的 评估卵巢癌组织中Grb相关结合蛋白2(Grb-associated binding protein 2,GAB2)的表达及其与预后的关系.方法 收集南通大学附属肿瘤医院2013年1月—2016年1月手术切除的119例卵巢癌组织及癌旁组织,利用免疫组织化学染色法检测组织中GAB2的表达情况,并分析其表达量与临床特征...     

合并重症肌无力对胸腺瘤术后患者预后的影响

目的 评价合并重症肌无力(Myasthenia gravis,MG)对胸腺瘤术后患者预后的影响,并对可能影响胸腺瘤术后患者预后的其他相关因素进行分析。方法 回顾性分析2002年9月—2018年1月中国人民解放军总医院第八医学中心收治的187例胸腺瘤术后患者的临床资料,其中胸腺瘤合并重症肌无力患者139例(MG组),单纯胸腺瘤患者48例(非MG组)。采用1∶1最邻近匹配法对两组患者行倾向性评分匹配(Propensity score matching,PSM),使组间协变量达到均衡。采用Kaplan-Meier法计算生存率,Log-rank检验比较两组患者生存曲线的差异,采用Cox比例风险回归模型对总体胸腺瘤术后患者进行单因素和多因素分析。结果 匹配前,MG组(n=139)与非MG组(n=48)患者的性别(χ²=4.180,P=0.041)、确诊年龄(χ²=8.590,P=0.003)、WHO组织学分型(χ²=4.764,P=0.029)以及是否接受术后辅助化疗(χ²=5.627,P=0.018)均存在统计学差异。两组患者的5年和10年生存率分别为92.4%和69.6%,76.9%和65.2%,两组生存曲线差异有统计学意义(P=0.002)。经PSM法匹配后,两组共44对患者成功匹配,两组患者临床基线资料差异均无统计学意义(P＞0.05)。两组患者的5年和10年生存率分别为90.8%和67.3%,85.6%和62.5%,两组生存曲线差异有统计学意义(P=0.015)。总体胸腺瘤术后患者的单因素分析显示,Masaoka分期(HR=0.237,95% CI:0.111~0.504,P＜0.001)、切除状态(HR=0.250,95% CI:0.096~0.654,P=0.005)、术后辅助化疗(HR=0.367,95% CI:0.179~0.751,P=0.006)以及合并重症肌无力(HR=0.336,95% CI:0.162~0.669,P=0.003)可能与胸腺瘤术后患者的生存预后相关。多因素分析结果显示,Masaoka分期是影响胸腺瘤术后患者生存的独立预后因素(HR=0.317,95% CI:0.140~0.720,P=0.006),合并重症肌无力则为影响胸腺瘤术后患者生存的保护性因素(HR=0.445,95% CI:0.204~0.971,P=0.042)。结论 对于可手术的胸腺瘤患者,合并重症肌无力较不伴重症肌无力的患者生存预后更好。Masaoka分期是影响胸腺瘤患者生存的独立预后因素。     

The prognostic value of hypoxia markers in T2-staged oral tongue cancer

Tumor hypoxia is associated with poorer outcome in patients with head and neck carcinomas, but little is known about hypoxia biomarkers in oral tongue cancer. We evaluated whether hypoxia biomarkers and clinicopathologic variables were prognostic predictors in patients with T2-staged squamous cell carcinoma (SCC) of the oral tongue. Tissue microarrays were constructed from formalin-fixed tumor blocks of 43 patients with T2-staged tongue SCCs treated by surgical resection and neck dissection. Tissue samples were stained with monoclonal antibodies to hypoxia-inducible factor (HIF)-1alpha, HIF-2alpha, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR). Locoregional control and survival rates were calculated by the Kaplan-Meier method, and prognostic factors were calculated from uni- and multivariate analyses. Tumor thickness was correlated with expression of CA-9 and GLUT-1 and nodal classification was correlated with GLUT-1 expression. The nodal metastasis rate was 51%, and the 5-year locoregional control and disease-specific survival (DSS) rates were 59% and 69%, respectively. Univariate analysis showed that HIF-1alpha and EPOR expression were significantly related to DSS. Multivariate analysis showed that EPOR expression was an independent predictor of DSS (P=0.030). EPOR expression may be an independent predictor for DSS in patients with T2-staged SCC of the oral tongue.     

Impact of treatment interruptions due to toxicity on outcome of patients with early stage (I/II) non-small-cell lung cancer (NSCLC) treated with hyperfractionated radiation therapy alone

We investigated the effect of treatment interruptions due to high-grade (3) toxicity on outcome of patients with early stage (I/II) non-small-cell lung cancer treated with hyperfractionated radiation therapy (Hfx RT). Of 116 patients treated with total tumour doses of 69.6 Gy, 1.2 Gy b.i.d. fractionation, 44 patients refused surgery while 72 patients were medically inoperable due to existing co-morbid states. Patients who were medically inoperable had worse KPS (P=0.0059) and more pronounced weight loss (P=0.0005). Among them, 12 patients experienced high-grade toxicity and 11 of them with either acute (n=6) or ‘consequential’ late (n=5) high-grade toxicity requested interruption in the Hfx RT course (range, 12–25 days; median, 17 days). Superior survival (OS) was observed in patients who refused surgery when compared to those who were medically inoperable (P=0.0041), as well as superior local recurrence-free survival (LRFS) (P=0.011), but not different distant metastasis-free survival (P=0.14). Cause-specific survival (CSS) also favoured patients who refused surgery (P=0.004). Multivariate analysis showed independent influence of the reason for not undergoing surgery on OS (P=0.035), but not on LRFS (P=0.084) or CSS (P=0.068). Patients who refused surgery did not experience high-grade toxicity (0/44), whereas 11 of 72 patients with medical inoperability and co-morbid states experienced high-grade toxicity and had treatment interruptions to manage toxicity (P=0.0064). Patients without treatment interruptions had significantly better OS (P=0.00000), LRFS (P=0.00000) and CSS (P=0.00000) than those with treatment interruptions. When corrected for treatment interruptions, the reason for not undergoing surgery independently influenced OS (P=0.040), but not LRFS (P=0.092) or CSS (P=0.068). In contrast to this, treatment interruption was independent prognosticator of all three endpoints used (P=0.00031, P=0.0075 and P=0.00033, respectively). When 11 patients with treatment interruptions were excluded, the reason for not undergoing surgery still affected OS (P=0.037) and CSS (P=0.039) but not LRFS (P=0.11). Multivariate analyses using OS, CSS and LRFS showed that the reason for not undergoing surgery affected OS (P=0.0436), but neither CSS (P=0.083) nor LRFS (P=0.080).     

舌鳞状细胞癌组织中硫氧还蛋白和硫氧还蛋白还原酶-1的表达及其意义

目的：研究硫氧还蛋白（Trx）和硫氧还蛋白还原酶-1（TrxR1）在舌鳞癌组织中的表达及其临床意义。方法：收集28例舌鳞癌组织和10例癌旁上皮组织,采用免疫组织化学SP三步法检测Trx和TrxR1蛋白在两种组织中的表达水平,并分析其表达与临床病理特征的关系。结果：舌鳞状细胞癌组织中的Trx和TrxR1蛋白表达水平明显高于癌旁正常上皮组织,癌组织和癌旁正常组织的Trx IOD值分别为（2.84±0.34）×10⁸和（3.91±3.00）×10⁷（P < 0.01）,TrxR1 IOD分别为（1.88±0.29）×10⁸和（0.69±0.32）×10⁷（P < 0.05）;Trx和TrxR1蛋白表达水平在不同肿瘤大小、分化程度组间表达的差异均具有统计学意义（P均 < 0.05）;Trx和TrxR1表达水平之间呈正相关关系（r=0.504,P < 0.05）,且Trx和TrxR1高表达组与低表达组的生存率差异具有统计学意义（P < 0.05）。结论：硫氧还蛋白及其还原酶-1可能为舌鳞状细胞癌的药物治疗靶点和早期诊断、肿瘤筛查的重要临床指标。     

化放疗模式下早期弥漫大B细胞淋巴瘤缩小放疗野对生存预后的影响

目的 探讨免疫化放疗时代Ⅰ~Ⅱ期弥漫大B细胞淋巴瘤(DLBCL)在PET/CT指导下缩小放疗野范围是否安全可靠。方法 选取我院化放疗后总体疗效达CR/PR且有PET/CT检查记录的57例Ⅰ~Ⅱ期DLBCL患者,分为靶区上、下界CTV外扩两组进行对比,主要研究目的:总生存期、无进展生存期,次要研究目的:无远处转移生存期、复发模式、放疗毒副反应。结果 中位随访31.1个月;靶区上界CTV≤4.74 cm与CTV＞4.74 cm组5年总生存率、无进展生存率、无远处转移生存率分别为:96.3%与77.1%(P=0.135),96.3%与59.5%(P=0.013),96.3%与69.3%(P=0.038);在CR组缩小靶区上界可延长PFS、DMFS(P=0.023)。多因素分析:靶区上界≤4.74 cm(P=0.039)为PFS的独立保护因素。其中≥3级远期放疗相关副反应均发生在CTV＞4.74 cm组(P=0.026)。结论 对于化疗后疗效评估CR或PR情况下,早期DLBCL的靶区上界缩小至CTV≤4.74 cm(INRT≤5 cm)而缩小下界至CTV≤8.5 cm(INRT≤8 cm)切实可行,在保证长期生存获益的同时可减少远期放疗副反应发生率,不增加局部复发及远处转移。