复发性口腔鳞癌挽救性手术近期疗效

目的　探讨不同期复发性口腔鳞癌挽救性手术治疗的疗效。方法　对 30例首次复发的复发性口腔鳞癌患者临床再分期后行挽救性手术并跟踪随访。结果　复发性口腔鳞癌早期患者的总生存时间及无瘤生存时间均比复发进展期者长 ,且复发早期 1年生存率及 1年无瘤生存率均高于复发进展期。结论　对复发性口腔鳞癌进行临床的再分期有利于评价预后及制定治疗方案 ;挽救性手术是复发性口腔鳞癌的有效治疗手段 ,尤其对复发性口腔鳞癌早期的患者     

Salvage surgery for recurrent carcinoma of the oral cavity: assessment of prognostic factors

Salvage surgery is the most acceptable therapeutic option for disease control of loco-regional recurrences in oral cancers. Prognostic factors need to be assessed to select patients for salvage surgery who would benefit the most. This was a single-centre retrospective observational study conducted between 2015 and 2018. A total of 168 patients with recurrent oral cavity carcinoma who underwent salvage surgery were included for analysis. The primary endpoints of the study were to evaluate overall survival (rOS) after salvage surgery and prognostic factors affecting survival. In this study, the median rOS was 18 months and the median disease-free survival (rDFS) was 14 months. Advanced stage (hazard ratio (HR) 2.387, 95% confidence interval (CI) 1.496–3.808; P = 0.001) and multimodality treatment (HR 1.642, 95% CI 1.139–2.367; P = 0.008) in the initial disease, as well as nodal spread (HR 3.794, 95% CI 1.580–9.111; P = 0.008) and perineural invasion (HR 2.167, 95% CI 1.358–3.455; P = 0.001) in the recurrent disease, were found to adversely affect survival after salvage surgery. With thorough assessment of the prognostic factors and appropriate patient selection, survival may be favourable after salvage surgery for recurrent oral cavity carcinoma.     

外周血嗜酸性粒细胞检测对口腔鳞状细胞癌术后的预后意义

目的探讨外周血嗜酸性粒细胞差异对口腔鳞状细胞癌术后患者的预后意义。方法回顾性分析2010年1月至2012年12月绍兴市人民医院口腔科住院并行手术治疗的口腔鳞状细胞癌患者62例,随访至2014年12月。计算嗜酸性粒细胞百分比及计数的均值,将患者分为大于等于均值组及小于均值组,比较两组患者术后的复发率,并将两组患者进行生存分析及多因素COX回归分析。结果按嗜酸性粒细胞计数均值分组,两组患者复发率及生存率差别均有统计学意义(P值分别为0.002和0.016)。按嗜酸性粒细胞百分比均值分组,两组患者复发率差异有统计学意义(P=0.005),生存率差异无统计学意义(P=0.253)。通过单因素生存分析,嗜酸性粒细胞计数是患者生存率的影响因素(P=0.030),多因素COX回归分析,嗜酸性粒细胞百分比与计数对生存率均无明显影响(P>0.05),而年龄及复发与否是患者生存率的影响因素(P<0.05)。结论口腔鳞状细胞癌术后早期患者外周血嗜酸性粒细胞百分比及计数减少提示该病复发的可能性大;尚无足够证据表明外周血嗜酸性粒细胞的改变将影响患者总体生存率。     

口腔鳞状细胞癌术后复发相关因素分析

目的    分析口腔鳞状细胞癌患者术后复发的相关临床因素。方法    随机抽取云南省第二人民医院口腔科2006年4月到2009年10月收治的62例口腔鳞状细胞癌患者的临床资料进行回顾性分析,记录患者原发肿瘤大小、区域淋巴结侵犯、邻近血管侵犯、邻近神经侵犯、手术切缘状况、淋巴结清扫数目、鳞状细胞癌的病理分级、年龄、性别等相关因素,并对数据进行相关分析。结果    对62例患者进行回顾性分析后,经统计学检验,不同的原发肿瘤大小、区域淋巴结侵犯、邻近血管侵犯、邻近神经侵犯、手术切缘状况、鳞癌的病理分级、年龄、性别的肿瘤复发差异均有统计学意义（均P＜0.05）。结论    口腔鳞状细胞癌术后复发与多种因素相关,应全面综合考虑,以降低患者术后的复发风险。     

The prognostic significance of histological features in oral squamous cell carcinoma

Background:  Different factors predict nodal metastasis, recurrence and survival in oral cancer. The aim was to assess the prognostic value of histological features related to the primary tumour.
Methods:  A total of 144 patients surgically treated at Odense University Hospital for oral cancer between 1999 and 2004 were included in the study. Postoperative radiation therapy was given in case of close and involved margins or high TNM stages (UICC 1997). Median follow-up time was 38 months. All surgical resections were reviewed and 22 histological characteristics were assessed.
Results:  The predominant sites were floor of mouth (FOM, 39%) and lateral tongue (35%). Fifty-nine per cent had UICC97 stage I–II disease. Five-year cause-specific survival was observed in 65%. Nodal involvement at diagnosis was observed in 36% which was significantly related to grade, neural and vascular invasion; surgical margins and increasing tumour depth. A cut-off value of 2 mm (4 mm for FOM) separated patients without and with nodal metastasis at the time of diagnosis. However, on multivariate analysis, neck disease was only associated with tumour depth and grade. Cox analysis of local recurrence in the oral cavity over time showed that tumour diameter and surgical margins were significant predictors while cause-specific survival was related to diameter, depth of invasion, surgical margins and extracapsular spread (ECS).
Conclusions:  Tumour depth and grade were strong prognostic factors for nodal metastasis, independently of other histological features. Tumour diameter and margins independently predict local recurrences in the oral cavity as well as cause-specific survival. Nodal involvement and ECS were associated with adverse prognosis.     

Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma

The purpose of this study was to evaluate the outcomes of second salvage surgery with extended vertical lower trapezius island myocutaneous flap (TIMF) reconstruction for patients with re-recurrent oral cavity and oropharyngeal squamous cell carcinoma (SCC). The subjects were 23 patients with advanced re-recurrent oral and oropharyngeal SCC undergoing second salvage surgery and reconstruction with a TIMF. A TIMF with a skin paddle measuring 6 cm × 7 cm to 10 cm × 22 cm was used to reconstruct the major defects. Three patients experienced minor complications: minor flap failure (n = 1), wound dehiscence at the donor site (n = 1), and an orocutaneous fistula (n = 1). The patients were followed for 3–72 months. Fifteen patients were alive with no evidence of disease, two were alive with disease, and six died of local recurrence or distant metastases. Second salvage surgery remains an effective treatment modality for select patients with advanced re-recurrent oral and oropharyngeal SCCs, and the extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing the major defect following second salvage surgery.     

Factors affecting surgical mortality of oral squamous cell carcinoma resection

Survival rates for oral squamous cell carcinoma (OSCC) has remained stagnant in recent years and improving surgical mortality could be an avenue to enhance outcomes. This systematic review aims to identify the causes of mortalities, determine both the modifiable and non-modifiable factors involved and target a reduction in postoperative 30-day mortality. In May 2019, a comprehensive search of key databases including PubMed, EMBASE, Cochrane Library was conducted. Blinded selection by two researchers identified papers that included participants who received oral squamous cell carcinoma resection and suffered an in-hospital or 30-day mortality. Selection identified two relevant papers that meet the inclusion criteria. One study had one death in its population sample but only had the cause of death described. Another study had an overall surgical mortality rate of 1% in a population of 21,681. Patients with multiple factors had the highest mortality rates; 4.6% in patients >85 years old and have a T4 diagnosis, 3.9% in patients with a Comorbidity Index ≥1 and a T4 diagnosis. These studies did not determine relationships between factors and causes of death. There are significant knowledge gaps in the literature, that can be addressed through further population analysis studies.     

Systemic inflammatory response in predicting outcomes of patients undergoing curative resection for oral squamous cell carcinoma

This study aimed to evaluate the prognostic significance of the modified Glasgow prognostic score (mGPS), neutrophil:lymphocyte ratio (NLR), and platelet:lymphocyte ratio (PLR) in patients undergoing resection of oral squamous cell carcinoma (OSCC) with curative intent. We also aimed to explore the relation between activated systemic inflammation and adverse tumour characteristics. Between February 2006 and December 2019, data on 825 patients undergoing curative resection of OSCC were retrospectively gathered. Preoperative C-reactive protein and serum albumin levels were obtained to calculate a mGPS. Full blood count parameters were collected to calculate NLR and PLR values. Categorical factors were analysed using the chi squared test. Multivariate regression was performed to identify independent prognostic variables and the predictive value of each model generated. For disease-specific survival (DSS) and overall survival (OS), mGPS (DSS and OS both p<0.001), NLR (DSS and OS both p<0.001) and PLR (DSS and OS both p<0.001) were significant on univariate analysis. Independent predictive variables for DSS included mGPS, clinical node stage, categorised depth of tumour invasion, non-cohesive invasive front, and lymphovascular invasion. The concordance index was acceptable (0.756) for this model. Replacing mGPS with NLR or PLR as a marker of systemic inflammation demonstrated the same preoperative variables as independently predictive for DSS. The concordance index for these models were acceptable (NLR 0.76 and PLR 0.756). The systemic inflammatory response is prognostically significant in patients undergoing curative resection of OSCC. The potential link between an inflammatory tumour microenvironment and activated systemic inflammation merits further investigation.     

血清SCC-Ag的变化对口腔鳞状细胞癌患者预后的影响

目的 研究血清鳞状细胞癌抗原(SCC-Ag)水平的变化对口腔鳞癌患者预后的影响。方法 采用ELISA检测了58例口腔鳞状细胞癌（鳞癌）患者手术前后血清SCC-Ag水平的改变。结果 术前及术后血清SCC-Ag值<1.5 μg/L的口腔鳞癌患者术后发生复发或转移发生率为15.6%和3.1%;术前和术后血清SCC-Ag水平>1.5 μg/L的口腔鳞癌患者术后发生复发或转移发生率为83.3%和95.5%;术前血清SCC-Ag水平>1.5 μg/L的口腔鳞癌患者术后血清SCC-Ag水平下降且SCC-Ag值<1.5 μg/L,其术后复发或转移发生率为25%。结论 血清SCC-Ag可能与口腔鳞癌的发生发展有关,其结果可作为判断患者病情的进展及肿瘤是否复发或转移。     

Clinical evaluation on controlling postoperative recurrence of oral squamous cell carcinoma by intracavity brachytherapy

The purpose of this research was to evaluate the clinical outcome and factors influencing postoperative intracavity brachytherapy in treating oral squamous cell carcinoma. As a part of their primary treatment, 108 patients received postoperative intracavity brachytherapy only and 85 patients received postoperative intracavity brachytherapy with external radiotherapy. 78 patients were given surgical treatment alone as a control. The survival rates and local tumor control rates were calculated and the therapeutic effects of various treatment methods compared. Overall 5- and 10-year survival rates for patients receiving surgical treatment alone, postoperative intracavity brachytherapy with or without external radiotherapy were 59% and 17%, 73% and 47%, 78% and 57%, respectively. The corresponding local tumor control rates were 53% and 51%, 73% and 71%, 75% and 73%, respectively. Surgical treatment with postoperative intracavity brachytherapy controlled tumor recurrence effectively (p < 0.01) and improved survival rates (p < 0.01). UICC stages, grading and tumor site had an important influence on overall survival and local tumor control rates. Local tumor excision followed by postoperative intracavity brachytherapy achieved good local tumor control and survival rate, and may be considered as a new and routine treatment for oral cancer.     

Prognostic significance of extranodal extension in oral cavity squamous cell carcinoma with occult neck metastases

A grade of extranodal extension (ENE) may advance risk stratification related to survival in patients with metastatic oral cavity squamous cell carcinoma (OCSCC). Pathological examination of 174 OCSCC patients who were primarily surgically treated with tumour resection and elective neck dissection was performed. Data of ENE presence, its extent (in millimetres), patients and tumour characteristics were statistically analysed with respect to disease-free survival (DFS) and overall survival (OS). Ninety patients (51.7%) were identified with occult nodal disease, with 41 patients (23.6%) presenting with ENE. Receiver operating characteristics (ROC) curve analysis set the threshold at 1.9 mm as an optimal ENE cut-off regarding both DFS and OS. Patients were divided by extent into minor ENE (≤1.9 mm) and major ENE (>1.9 mm) subgroups. The subgroup with minor ENE had significantly higher DFS and OS rates compared with major ENE. ENE cut-off threshold at 1.9 mm discriminates low and high-risk subgroups of patients with occult OCSCC in terms of DFS and OS.     

Morphological changes of regional lymph node in squamous cell carcinoma of the oral cavity

BACKGROUND: Regional immune responses with various types of cancer have been studied histopathologically, however, the prognostic value remains conflicting. The aim of this study was to evaluate morphological changes related to lymph node metastasis and the prognostic value for oral cavity squamous cell carcinoma. METHODS: With histopathologic whole architecture of 430 lymph nodes, gross area, germinal center (GC) area, paracortical area (PA), and tumor area were measured. RESULTS: Metastatic node had significantly lower distribution ratio of PA to lymphoarea than that of tumor-free node. GC area was not constantly associated with lymph node metastasis. In Cox multivariate analysis, the mean ratio of PA to gross area/lymphoarea was an independent prognostic factor. CONCLUSIONS: The proportion of PA to gross/lymph area was associated with lymph node metastasis and long-term survival and may be useful in stratification of those patients for a requirement of adjuvant treatments.     

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。