口腔癌颈部N0淋巴结的诊断与处理

对口腔癌颈部N0淋巴结的处理存在两种主张：赞成进行治疗的认为，约30％N0淋巴结存在隐匿转移，因此有必要治疗，而且颈部淋巴结选择性治疗预后比治疗性好；反对的意见认为，选择性治疗预后不一定好于治疗性，而且约有70％患者承受了不必要的治疗，无论是切除淋巴结或是对淋巴结进行放疗都可能降低机体的免疫功能。产生上述两种截然不同观点的根本原因是目前还缺乏一种诊断颈部转移淋巴结的特异检查方法，     

前哨淋巴结活检判断口腔癌颈部淋巴结转移的系统评价

目的:系统评价前哨淋巴结活检(SLNB)预测口腔癌颈淋巴结转移的临床价值。方法:通过计算机检索CENTRAL、Medline、EMBASE、IFCC、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(CQVIP)、万方数据库等,收集应用前哨淋巴结活检判断口腔癌颈淋巴转移的诊断试验,应用统计软件Meta-DiSc 1.4进行数据分析。结果:纳入分析的文献9篇,前哨淋巴结活检判断口腔癌颈淋巴转移的敏感度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及系统接收操作特性曲线(SROC)下面积分别为84%(95%CI 73%～92%)、100%(95%CI97%～100%)、19.16(95%CI 7.65～47.77)、0.22(95%CI 0.10～0.51)、97.72(95%CI 29.69～321.61)和0.99。结论:前哨淋巴结活检可作为临床上判断口腔癌颈淋巴结转移有效可行的方法。     

口腔癌淋巴结转移的早期诊断新进展

对口腔癌早期颈淋巴转移进行准确诊断将有助于提高诊断的准确率,提高患者的生存质量.随着癌症发病机制研究的不断深入及分子生物学技术的飞速发展,人们开始尝试从基因水平上预测口腔癌早期的淋巴转移.本文从临床检查、影像学检查、前哨淋巴结病理检测和基因蛋白分子检测及联合应用等方面对近几年来口腔癌早期淋巴转移的诊断方法做一综述.     

超声检查在口腔癌淋巴结转移诊断中的作用

本研究对 47例口腔癌患者颈淋巴结超声检查进行前瞻性研究 ,并与触诊检查进行对比 ,初步评价超声检查在转移淋巴结诊断中的作用。一、材料与方法本研究共有 47例口腔癌患者 ,其中男性 36例 ,女性 1 1例 ,年龄 30岁～ 72岁 ,平均年龄 46 .8岁。 47例患者中 ,舌癌32例 ,口底癌 1 0例 ,颊癌 5例 ,所有患者符合以下条件 :①有活检证实 ;②以前未做过放、化疗及手术治疗 ;③以局部扩大切除同期行颈淋巴清扫术作为初次基本治疗方法。在术前 ,对每位患者的患侧颌下区颈部进行触诊及超声检查 ,先详细记录触诊查到的肿大淋巴结的数量、大小、质地、活…     

哨位淋巴结活检在早期口腔癌中的应用

哨位淋巴结活检（SNB）在口腔鳞癌（OSCC）中的研究已经有10余年的历史。大量的研究报道及科学数据肯定了其取代选择性颈淋巴清扫手术的作用。     

口腔癌对侧颈淋巴结转移的高危因素分析

目的：分析影响口腔癌患者发生对侧颈淋巴结转移的临床病理因素.方法：收集2010年6月～2011年6月间217例中发生对侧颈淋巴结转移的口腔癌病历资料13例,对其临床病理特点进行分析.结果：口腔癌对侧颈淋巴结转移多发于年轻患者,部位以舌、口底常见,并与临床分期、病理分级、同侧颈淋巴转移等因素密切相关,其协同作用可能加快其转移.结论：在≤45岁、肿瘤范围越过中线、侵及口底、≥T3期、低分化鳞癌、同侧颈淋巴结转移等因素中若出现两项或以上者,则有必要考虑同期行对侧颈淋巴结清扫术,以提高患者治愈率和生存率.     

口腔癌引流区淋巴结反应性增生与微转移关系的研究

目的：明确口腔癌引流区淋巴结反应性增生与微转移之间的联系。方法：收集四川大学华西口腔医院住院治疗的12例口腔鳞癌患者术后颈部淋巴结标本共233个，通过病理检测分为正常、反应性增生和转移3组，采用免疫组化检测前2组微转移，结果使用SPSS10．0进行统计学分析。结果：25个淋巴结病理检查为转移，79个反应性增生，129个正常；正常黏膜上皮、鳞状细胞癌与转移淋巴结呈角蛋白强阳性，反应性增生与正常淋巴结的微转移检出率分别为29／79、12／129。结论：癌引流区反应性增生的淋巴结较正常淋巴结更易出现微转移。     

口腔癌肿瘤出芽与VEGF-C的表达及淋巴结转移的相关性研究

目的:探讨口腔癌中肿瘤出芽与VEGF-C表达及淋巴结转移的相关关系。方法:通过HE染色观察57例口腔癌,参照Ueno标准判断肿瘤出芽情况,采用免疫组化(SP法)技术检测VEGF-C表达,分析肿瘤出芽、VEGF-C表达与临床病理因素间的关系。结果:57例口腔癌的肿瘤出芽率为63.16%,肿瘤出芽预测口腔癌淋巴结转移灵敏度为91.67%;VEGF-C在口腔癌中表达阳性率为52.63%,二者均与淋巴结转移、临床分期呈正相关关系(P<0.05)。肿瘤出芽与VEGF-C的表达符合率为68.42%。结论:肿瘤出芽可作为口腔癌判断淋巴结转移的预测因子。     

口腔癌早期诊断的研究现状

口腔癌是第6位常见的癌症,预后较差,5年生存率在50%左右,早期诊断和早期治疗是提高患者生存率和生存质量的关键。但当患者出现如疼痛、出血、溃疡、肿块、影响语言或吞咽疼痛等临床症状时,肿瘤可能已经出现了浸润和转移。因此,如何在患者出现临床症状前,筛选出口腔癌高危人群,实现早期诊断,是所有临床医师努力的目标。临床上除了常规的检查口腔病变(包括由口腔科医师、耳鼻咽喉科医师和内科医师检查)外,口腔组织的活体染色、光谱分析和刷取活检等手段有望实现口腔癌的早期诊断。     

T1和T2期口腔癌的颈部处理

该文为回顾性研究，评价了T1和T2期口腔癌患者的颈部转移灶控制情况及其生存率。171例口腔鳞状细胞癌患者均进行了原发灶切除。21例可触及颈部明显淋巴结者，接受治疗性颈清扫术，未触及淋巴结者150例，75例进行了选择性颈清扫术．75例进行了随诊观察。是否施行选择性颈清扫术依据于临床标准，而非随机。     

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提要：口腔癌是全身第6位常见肿瘤,近几十年5年存活率没有明显改善,严重危害患者的生命和生存质量。其中一个主要原因是由于缺乏行之有效的监测和筛查早期口腔癌的方法。本文旨在结合笔者多年从事临床病理的经验,对检测早期口腔癌的方法进行评述。除作为金标准的组织学检查外,细胞学检查、DNA定量分析、分子生物学检查将有望成为早期口腔癌检测及筛查的重要手段。     

Prognostic value of lymph node count from selective neck dissection in oral squamous cell carcinoma

Unlike the levels of anatomical exploration, there is no consensus on the extent of lymph node dissection, or lymph node count (LNC), during selective neck dissection (SND). The aim of this study was to validate the prognostic impact of LNC on survival and to determine an optimal LNC cut-off value for SND. A retrospective investigation identified 78 patients with a diagnosis of oral squamous cell carcinoma (OSCC) who underwent SND (levels I–III or levels I–IV). LNC and clinicopathological variables were analyzed for any association with survival in Cox proportional hazards models. Based on the receiver operating characteristic curve, a cut-off value of 19 lymph nodes was found to predict overall survival (OS) (area under the curve 0.732, sensitivity 67.8%, specificity 75.0%; P = 0.026) and disease-specific survival (DSS) (area under the curve 0.762, sensitivity 68.1%, specificity 77.8%; P = 0.011). On Cox regression, LNC (≥19 vs. <19) was the only independent predictor of OS (hazard ratio 5.29, 95% confidence interval 1.39–20.05; P = 0.014) and DSS (hazard ratio 6.76, 95% confidence interval 1.40–32.77; P = 0.018). Similar results were obtained in the pathologically lymph node-negative subgroup (n = 66). Based on the study findings, SND should include 19 or more lymph nodes for a survival benefit.     

The prognostic significance of the lymph node ratio in oral cancer differs for anatomical subsites

The aim of this study was to validate the prognostic significance of the lymph node ratio (LNR) in patients suffering from oral squamous cell carcinoma in regard to different anatomical subsites. A cohort of 430 patients was investigated to determine the rates of primary metastasis and local and regional disease recurrence. Correlation analysis of the LNR with relevant clinical and pathological parameters was performed. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the prognostic impact for different subsites. Significantly differing rates of primary metastasis and loco-regional disease recurrence were found for cancer of different anatomical subsites of the head and neck. Furthermore, ROC curve analysis suggested that LNR has prognostic relevance in subsets of cancer (tongue, P <  0.001; alveolar process, P =  0.04; maxilla, P =  0.03; buccal mucosa, P =  0.02). The LNR of cancer located in the soft palate (P =  0.6) and floor of the mouth (P =  0.11) showed little or no association with the clinical outcome. There is the need for a more sensitive consideration of the LNR as a factor in the assessment of risk and the treatment decision, as the anatomical subsite plays a crucial role in its impact on the clinical outcome.     

VEGFR—3表达与口腔癌淋巴道转移的关系

目的　了解血管内皮生长因子 (VEGF C)及血管内皮生长因子受体 3(VEGFR 3)在正常口腔黏膜、白斑及鳞癌等组织中的表达规律。方法　采用免疫组化染色及图像分析方法 ,确定VEGFR 3的表达及定量。结果　VEGFR 3主要表达定位在脉管结构 ,在正常及病变上皮组织中也有少量表达。口腔癌VEGF C表达阳性之VEGFR 3染色脉管数目比阴性增多 ,淋巴结转移比无转移增多 (P <0 .0 1) ;而鳞癌比正常黏膜、白斑增多 (P <0 .0 5 ) ;随临床分期或病理分级增高 ,VEGFR 3染色脉管数目有增多趋势 ,但无统计学差异 (P >0 .0 5 )。结论　VEGF C表达的增高 ,通过其受体VEGFR 3导致了淋巴管的增生 ,这种增生在肿瘤情况下很可能导致了淋巴道转移的增加     

Endothelial cell Bcl-2 and lymph node metastasis in patients with oral squamous cell carcinoma

J Oral Pathol Med (2012) 41 : 124–130 Background: Loco‐regional spread of disease causes high morbidity and is associated with the poor prognosis of malignant oral tumors. Better understanding of mechanisms underlying the establishment of lymph node metastasis is necessary for the development of more effective therapies for patients with oral cancer. The aims of this work were to evaluate a possible correlation between endothelial cell Bcl‐2 and lymph node metastasis in patients with oral squamous cell carcinoma (OSCC), and to study signaling pathways that regulate Bcl‐2 expression in lymphatic endothelial cells. Methods: Endothelial cells were selectively retrieved from paraffin‐embedded tissue sections of primary human OSCC from patients with or without lymph node metastasis by laser capture microdissection. RT‐PCR was used to evaluate Bcl‐2 expression in tumor‐associated endothelial cells and in tumor cells. In vitro, mechanistic studies were performed to examine the effect of vascular endothelial growth factor (VEGF)‐C on the expression of Bcl‐2 in primary human lymphatic endothelial cells. Results:  We observed that Bcl‐2 expression is upregulated in the endothelial cells of human oral tumors with lymph node metastasis as compared to endothelial cells from stage‐matched tumors without metastasis. VEGF‐C induced Bcl‐2 expression in lymphatic endothelial cells via VEGFR‐3 and PI3k/Akt signaling. Notably, OSCC cells express VEGF‐C and induce Bcl‐2 in lymphatic endothelial cells. Conclusions: Collectively, this work unveiled a mechanism for the induction of Bcl‐2 in lymphatic endothelial cells and suggested that endothelial cell Bcl‐2 contributes to lymph node metastasis in patients with oral squamous cell carcinoma.     

Sentinel lymph node biopsy with preoperative CT lymphography and intraoperative indocyanine green fluorescence imaging for N0 early tongue cancer: A long-term follow-up study

PurposeThis study evaluated the usefulness of sentinel lymph node (SLN) biopsy with preoperative computed tomographic lymphography (CTL) and intraoperative indocyanine green (ICG) fluorescence imaging for N0 early tongue cancer.MethodsTwenty-seven patients with N0 early oral tongue cancer underwent CTL with a 128-slice multi-detector row CT scanner to detect SLN on the day before resection of primary tumor and SLN biopsy under ICG fluorescence guidance. We identified the location and number of SLNs mapped by CTL and evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. Prognosis was also evaluated.ResultsSLNs were detected by CTL in 26 of 27 patients (96.3%). The total and mean numbers of SLNs were 41 and 1.5, respectively. All SLNs enhanced by CTL could be identified intraoperatively as ICG fluorescent lymph nodes. Two SLNs were found under ICG fluorescent guidance in only one patient without SLN enhanced by CTL. Among the 27 patients, five (18.5%) had SLN with metastasis. Median follow-up was 76 months (range 44–82 months). During follow-up, three of 22 patients without SLN metastasis had occult cervical lymph node metastasis. The 5-year overall survival rate was 100%.ConclusionSLN biopsy with preoperative CTL and intraoperative ICG fluorescence imaging is a feasible and reliable procedure, without radioisotope tracers, for neck management in cases of early tongue cancer.     

口腔癌前哨淋巴结活检价值的系统评价

目的:探讨前哨淋巴结活检(SLNB)对于判断口腔癌颈淋巴结转移的敏感性和特异性及临床预测价值.方法:计算机检索PubMed、EMBASE、CENTRAL、中国期刊全文、万方、中国生物医学文献等相关数据库,搜集已公开发表的有关SLNB预测口腔癌颈淋巴结转移的相关诊断试验,应用Meta-disc 1.4统计软件进行分析,评价SLNB预测口腔癌颈淋巴结转移敏感性、特异性和受试者工作特征曲线(ROC)下面积(AUC).结果:最终共25项诊断实验、934例受试者纳入本研究.Meta分析结果显示SLNB预测口腔癌颈淋巴结转移敏感性和特异性分别为91％(95％ CI 88％-94％)和100％(95％ CI 99％-100％);综合受试者工作特征曲线(SROC)下面积(AUC)为0.99.结论:SLNB预测口腔癌颈淋巴结转移敏感性、特异性均较高,作为判断颈淋巴结转移的标准有较高的临床应用价值.     

Sentinel lymph node biopsies in early stage oral and oropharyngeal carcinoma: a retrospective single-centre experience

The aim of this retrospective study was to analyse a consecutive series of patients with oral and oropharyngeal carcinoma who had had sentinel lymph node biopsy (SLNB) at our hospital during 2008-2017. A total of 70 patients with clinically and radiologically confirmed primary oral (n = 67) or oropharyngeal (n = 3) carcinoma, with no signs of metastatic lymph nodes preoperatively (clinically N0) were included. Patients’ clinical and personal data, characteristics of the tumours, sentinel lymph node (SLN) status and outcomes were recorded. Eight patients had invaded SLN. Two patients with clear sentinel lymph node biopsies had recurrences in the cervical lymph nodes with no new primary tumour as origin. The negative predictive value (NPV) and sensitivity for SLNB were 97% and 80%, respectively. The depth of invasion was an individual predictor for cervical lymph node metastasis (p = 0.043). Single photo emission computed tomography (SPECT) detected fewer SLN in patients with invaded lymph nodes than in patients with clear lymph nodes (p = 0.018).Our data support the use of SLNB as a minimally invasive method for staging the cervical lymph nodes among patients with cN0 oral and oropharyngeal carcinoma. Our results further confirm that greater depth of invasion is associated with cervical lymph node metastases.     

前哨淋巴结活检对早期口腔鳞状细胞癌颈淋巴结转移诊断的Meta分析

目的 系统评价前哨淋巴结活检用于口腔鳞状细胞癌早期颈部转移诊断的临床价值.方法 检索Cochrane图书馆(cochrane library,CL)对照试验注册资料库、循证医学数据库、PubMed数据库、中国知网2001-2011年国内外关于前哨淋巴结活榆确定早期口腔鳞状细胞癌患者颈淋巴转移的文献共42篇.筛选出文献12篇,记录数据,用Meta分析的相关软件Metadisc 1.4进行统计学分析.结果 12项研究的患者共793例,最后合并的早期口腔鳞状细胞癌患者前哨淋巴结活检敏感度和特异度分别为0.86(95％可信区间:0.81 ～0.90)和0.99(95％可信区间:0.98～1.00).结论 对于早期口腔鳞状细胞癌患者前哨淋巴结活检的敏感度和特异度较高、准确率高,可以判定颈部淋巴结是否转移,以及是否需要行颈淋巴结清扫术.