336例HPV相关性与非相关性口咽鳞癌患者生存分析

目的: 分析比较HPV相关性与非相关性口咽鳞癌（oropharyngeal squamous cell carcinoma,OPSCC）患者在新、旧版TNM不同分期情况下,患者生存及预后差异,为OPSCC的治疗策略与预后评估提供临床依据。方法: 收集2010年1月—2016年12月青岛大学附属医院手术治疗的原发OPSCC患者,采用p16免疫组织化学检测方法对病理标本重新进行评估,统计患者生存信息,并分别运用第7版、第8版TNM分期系统对肿瘤进行分期,记录新、旧版的降级情况,分析、比较HPV相关性与非相关性OPSCC患者两版不同分期对生存率及预后的影响。采用SPSS 25.0软件包对数据进行统计学分析。结果: 最终纳入336例OPSCC患者,其中HPV相关性OPSCC患者101例（30.1%）,5年生存率为47.5%（48/101）,中位生存时间58个月;非相关性OPSCC患者5年生存率为34.0%（80/235）,中位生存时间37个月。HPV相关性OPSCC患者第8版TNM分期与第7版TNM分期对比,其总体降级率为77.2%（78/101）,晚期患者降级率为100%（69/69）,晚期患者中降至早期的患者占比69.6%（48/69）。结论: HPV相关性OPSCC患者的生存率和生存中位时间明显优于非相关性OPSCC患者,第8版TNM分期手册的OPSCC分期相比第7版更符合临床实际,预后分层更加清晰,能更好指导临床决策。     

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...     

口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读

美国癌症联合委员会《AJCC肿瘤分期手册》与美国国立综合癌症网(NCCN）肿瘤学临床实践指南已广泛用于临床实践中。NCCN肿瘤诊治指南与TNM分期密切相关,指南为不同TNM分期的肿瘤制定了较为详细的诊治标准,作为依据指导临床应用。2017年第8版口腔及口咽癌TNM分期新增了较多内容,如侵袭深度（DOI）、淋巴结外扩展（ENE）、人乳头瘤病毒（HPV）等指标用于了新的分期中,并且为HPV相关的口咽癌制定了一个新的TNM分期。2018年版NCCN口腔与口咽癌指南及时反映了第8版口腔及口咽癌TNM分期中新的变化,同时亦为HPV相关的口咽癌制定了相应的诊治指南。新的TNM分期及NCCN诊治指南对口腔与口咽癌患者诊疗策略的制定及治疗方案的选择具有较大的指导意义。为了临床工作的需要,本文结合两者的变化进行了部分解读。     

2019年NCCN口腔口咽癌诊疗指南更新解读

美国癌症联合委员会2017年第8版《AJCC肿瘤分期手册》出版,口腔及口咽癌TNM分期标准中新增侵袭深度（DOI）、淋巴结外扩展（ENE）、人乳头瘤病毒（HPV）等指标,并将口咽癌分为HPV阳性（p16+）与HPV阴性（p16-）,分别制定了不同的TNM分期标准。2018年,美国国立综合癌症网（NCCN）首次为HPV阳性（p16+）口咽癌制定了诊疗指南。2019年第1版NCCN头颈癌诊疗指南已经发布,其中对口腔口咽癌指南做了部分修订。为临床工作需要,本文结合2版变化进行部分解读。     

68例HPV相关口咽鳞癌患者生存分析

目的 探讨口咽癌HPV适用检测方法并比较HPV阳性患者新、旧版肿瘤TNM分期降级后的预后差异,为指导HPV相关口咽癌的精准诊疗提供临床依据。方法 对171例口咽鳞状细胞癌（简称鳞癌）患者,分别行脱落细胞学、P16免疫组织化学及HPV-RNA PCR检测HPV,比较3种检测方法的结果。分析68例HPV相关口咽鳞癌患者的临床及病理资料,根据新、旧版TNM分期标准对其重新分期,了解降级情况,统计各期患者生存率,比较新、旧2版分期患者的预后,应用 Kaplan-Meier方法建模,采用SPSS 22.0 软件包进行统计学分析。结果 免疫组织化学P16检测、口咽脱落细胞检测和PCR检测的口咽癌HPV阳性检出率分别为25.7%、14.6%和24.0%,脱落细胞检测与其他2种检测均有统计学差异（P=0.000）,免疫组织化学和PCR检测无统计学差异（P=0.205）。68例HPV阳性口咽鳞癌患者按照第7版与第8版TNM标准分期,分别为Ⅰ期3和42例,Ⅱ期7和14例,Ⅲ期17和9例,Ⅳ期41和3例。第7版与8版分期患者3年生存率比较,Ⅰ期100.0%和89.7%（P=0.672）,Ⅱ期68.6%和61.9%（P=0.961）,Ⅲ期66.8%和37.0%（P= 0.043）,Ⅳ期74.8%和0.00%（P=0.000）。第7与8版分期的早期患者（Ⅰ、Ⅱ期）生存率比较,78.8%和82.7%（P=0.585）,晚期患者（Ⅲ、Ⅳ期）生存率比较,71.2%和27.8%（P =0.000）。HPV阳性患者按照第7版分期,早期与晚期患者生存率为78.8%和71.2%（P=0.982）;按照8版分期,早期与晚期患者生存率为82.7%和27.8%（P=0.000）。结论 脱落细胞检查不宜作为诊断HPV阳性口咽鳞癌的单一标准,P16免疫组织化学检测和PCR基因检测各有优缺点,应根据实际情况选择。对于HPV阳性口咽鳞癌患者,新版分期更符合临床实际情况,预后分层更加清晰,能更好指导临床决策,值得临床推广应用。     

基于SEER数据库的颊黏膜鳞状细胞癌的预后列线图构建

目的: 基于监测、流行病学和最终结果（SEER）数据库构建颊黏膜鳞状细胞癌（BMSCC）患者预后列线图模型。方法: 通过SEER数据库,纳入原发性BMSCC患者583例。利用R语言（R 3.6.0）进行列线图模型构建,Cox比例风险模型分析与BMSCC预后相关的危险因素,最终根据Cox比例风险模型分析结果构建列线图。通过与TNM分期系统比较一致性与区分度,评估模型的预测效果;绘制校准曲线与一致性指数,评价模型的一致性。采用SPSS 22.0软件包绘制受试者工作特征曲线与Kaplan-Meier生存曲线,评价模型的区分度。结果: 多因素Cox分析显示,年龄、T分期、N分期是BMSCC患者预后的独立危险因素并纳入列线图构建。列线图组的校准曲线与一致性指数均显著优于TNM分期组。列线图组受试者工作特征曲线与Kaplan-Meier生存曲线区分度均优于TNM分期组。列线图模型在BMSCC患者生存率预测的一致性与区分度上均优于TNM分期系统。结论: 基于SEER数据库构建的针对BMSCC预后的列线图预测模型,比TNM分期系统具有更好的预测效能。     

638例舌鳞癌预后及影响因素分析

目的:研究舌鳞癌患者人口学及临床病理特征对总生存率的影响,筛选可能的预后影响因素.方法:选择2003—2013年间在上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科经病理确诊为舌鳞癌、户籍所在地为上海的住院患者.从住院病史中提取年龄、性别等人口学特征,病变部位、TNM分期、临床分期、组织学分级等临床病理特征数据....     

对口腔癌UICC1987年TNM分期的看法

头颈肿瘤医生主要研究头颈部肿瘤的诊治及预防。目前如何在肿瘤病因不明的情况下,制订治疗计划,判断预后,提出防治意见,只有依靠大量的临床前瞻及回顾性资料,进行具体、仔细的分析,提出科学根据,在临床实践中,总结临床经验,更好地为癌症病人服务。UICC的TNM分期就是为了这个目的,而制定对恶性肿瘤的分期的。今就对此1978年及1987年口腔癌TNM分期进行讨论。     

恶性肿瘤TNM分类分期总则

由著名口腔颌面外科专家邱蔚六教授编译的“头颈部恶性肿瘤TNM分类分期”1987、UICC,将陆续在本刊分期登出,这将对临床医师制定治疗计划,估计预后,以及进行国际交流等提供更为规范化的标准。本期先登出《恶性肿瘤TNM分类分期总则》供广大临床医师应用及参照。     

腮腺癌术后放疗的评价

目的 :评价腮腺癌术后放射治疗的价值及影响预后的因素。方法 :86例经病理证实的腮腺癌 (Ⅰ期 7例 ,Ⅱ期 2 8例 ,Ⅲ期 3 3例和Ⅳ期 18例 )术后采用 60Coγ线或直线加速器X线和电子束进行放射治疗 ,并随访 5年以上。结果 :5年生存率 73 .3 % ,5年肿瘤局部控制率 87.2 %。病理类型中未分化癌、鳞癌和恶性多形性腺瘤预后差 ,而腺泡细胞癌和粘液表皮样癌预后较好。临床分期Ⅲ、Ⅳ期预后较差。放疗应在术后 2周开始 ,剂量以 5 1～ 60Gy较好 ,5年生存率为 82 .9%。结论 :腮腺癌应采用手术加放疗的综合治疗 ,放疗应在术后 2周开始 ,肿瘤剂量 5 1～ 60Gy为宜 ,病理类型及临床分期为影响预后的重要因素     

Is the 8th edition of the Union for International Cancer Control staging of oral cancer good enough?

Depth of invasion is an important predictor of survival. A study by the International Consortium (ICOR) for Outcome Research proposed incorporation of it (together with the greatest surface dimension, or the anatomical criteria, or both) into the T stage. This has been adopted in part by the 8th edition of the Union for International Cancer Control (UICC) TNM 8 classification of malignant tumours for oral squamous cell carcinoma (SCC). Our aim was to verify depth of invasion as an independent prognostic factor, and to validate the staging by comparing it with that specified in the 7th edition (TNM 7) and the T-staging model proposed by the International Consortium. We retrospectively studied 449 patients who had had operations for a previously untreated primary oral cancer between 2006 and 2014 at a single centre, and analysed the independent predictive value of depth of invasion for both disease-specific and overall survival. It was an independent predictor of disease-specific survival as were sex, perineural invasion, and N stage. It was also an independent predictor of overall survival together with sex and N status. Staging in TNM 8 gave a better balance of distribution than that in TNM 7, but did not discriminate between prognosis in patients with T3 and T4 disease. The proposed International Consortium rules for T-staging gave an improved balance in distribution and hazard discrimination. The incorporation of depth of invasion into the T-staging rules for oral SCC improved prognostic accuracy and is likely to influence the selection of patients for adjuvant treatment. Our findings suggest that the TNM 8 staging lacks hazard discrimination in patients with locally-advanced disease because its T4 staging is restricted to anatomical criteria.     

Prognosis of oral cancer: a comparison of the staging systems given in the 7th and 8th editions of the American Joint Committee on Cancer Staging Manual

The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual introduces “depth of invasion” and “extranodal extension” into the head and neck section, and our aim was to find out if these changes have an impact on prognosis. We evaluated 174 patients who had had oral squamous cell carcinomas (SCC) resected between 2003 and 2012. The clinical records were reviewed, the patients’ tumours restaged according to the 8th edition of the AJCC, and we analysed five-year survival to verify whether different correlations were made between the T and N stages and disease-specific survival using the 7th and 8th editions. We excluded seven cases because information was incomplete, and the final sample was 167 patients. The five-year overall survival was 68% and the five-year disease-specific survival was 78%. The variable pT was upstaged in 51 patients (31%), and no tumour was downstaged. When we used the 7th edition, the pT category did not correlate with survival (p = 0.055), but when we used the 8th edition, there was a significant association between increased pT categories and disease-specific survival (p = 0.01). In the pN category 23 cases were upstaged (14%) and this affected disease-specific survival using both the 7th and the 8th editions (p = 0.001). When patients were restaged, there was an improvement in discrimination between T categories in relation to disease-specific survival, and confirmation of the prognostic impact of the variable pN. T stage and depth of invasion are complementary predictors of disease-specific survival, and their combination results in the new AJCC staging system giving a better prognosis.     

Validation of the UICC 8th edition staging of oral cavity squamous cell carcinoma in a UK cohort

The eighth edition of the Union for International Cancer Control (UICC) staging manual was recently introduced. The staging of oral cavity squamous cell carcinoma saw changes in relation to depth of invasion and extra-nodal extension. We aimed to evaluate this system and its prognostic ability in a UK cohort. A retrospective review was undertaken of patients diagnosed with squamous cell carcinoma (SCC) of the oral cavity between January 2009 and December 2013. Data were collected on demographics, histology, and recurrence-free (RFS) and five-year overall survival (OS). Patients were staged using both the seventh and eighth editions of the UICC staging manual. Stage-specific survival analysis was performed using the Kaplan-Meier method. A total of 191 records were reviewed and 87 were included in the analysis. The mean (range) age was 60 (37-88) years, and 53% were male. The tongue was the most common site (51%). Using the seventh edition patients were staged as stage I = 30, II = 14, III = 7, IVa = 35, and IVb = 1. Applying the eighth edition, 26 patients (30%) were upstaged (I = 24, II = 15, III = 14, IVa = 17, IVb = 17). Ten were upstaged based on pT and 16 on pN status. Both staging manuals showed statistically significant discrimination between stages for both OS and RFS. Patients upstaged from stage IVa in the seventh edition had significantly worse OS in the new system (p = 0.043). Both staging systems discriminated accurately between stages. Patients upstaged in stage IVa showed significantly worse OS suggesting improved prognostication with the eighth edition and the changes introduced.     

Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition

According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10 mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10 mm and a tumour diameter >4 cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10 mm and a tumour diameter <4 cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10 mm with tumour diameter below or above 4 cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10 mm may not be warranted in the absence of other risk features such as nodal disease or close margins.     

影响口底癌疗效的相关因素分析

口底癌在口腔鳞癌手术治疗中具有挑战性,该区解剖复杂、手术入路受限、切缘阳性率较高、常发生双侧颈淋巴结转移。虽然TNM分期系统常用于制定手术计划,但肿瘤的其他病理特点（浸润深度、肿瘤浸润方式、阳性淋巴结比等）亦有助于指导治疗决策以及预后评估。累及范围较广泛的肿瘤,间室外科或拉通术可明显改善局部-区域控制率。切缘＞5 mm病例术后局部控制率和生存率较高。与下颌骨紧贴或浅层侵蚀的口底癌,边缘性下颌骨切除术是安全有效的。早期口底癌可发生隐匿性淋巴结转移,但是否行选择性颈淋巴清扫术尚无一致意见;由于Ⅳ 、Ⅴ区很少发生转移,因此常采用肩胛舌骨上颈清术。局部晚期的病变,常发生多个淋巴结转移、包膜外扩展、神经浸润以及切缘阳性,术后放疗可提高局部控制率和生存率。     

Lymphovascular invasion as a prognostic tool for oral squamous cell carcinoma: a comprehensive review

Oral cancer is the most common malignancy of the head and neck region, characterized by a poor prognosis. Novel prognostic markers are needed to better stratify these patients. Lymphovascular invasion (LVI) has been included in the eighth edition of the AJCC Cancer Staging Manual as an additional prognostic factor, but its influence on the recurrence risk and lymph node metastasis is relatively understudied. This is a comprehensive review of the literature on the clinical and prognostic role of LVI in oral cancer. A relevant search of the PubMed, Scopus, and Web of Science databases yielded 29 articles that satisfied the inclusion criteria. Findings indicated that LVI is an independent negative prognostic factor in oral cancer patients and appears to be associated with cervical lymph node metastasis and loco-regional recurrence. Notably, in oral tongue cancer, survival outcomes progressively worsen when LVI is associated with other adverse pathological features, especially in the early stages. Therefore, these patients could benefit from elective neck dissection and/or adjuvant therapy. The high variability of LVI prevalence hinders the comparison of literature results. Several methodological limitations were found to be present in the collected articles, including the lack of a rigorous definition for LVI, the difficult detection in routine histological section, the presence of potential confounders, the retrospective nature, and an inadequate sample size in most studies. Therefore, it is necessary to conduct prognostic studies using standardized methods to define and quantify LVI.