Stage I-II squamous cell carcinoma of the oral cavity treated by iridium-192: is elective neck dissection indicated?

This is a retrospective analysis of 233 evaluable patients with stage I-II squamous cell carcinoma of the oral cavity treated by definitive branchytherapy. Minimum follow-up is 3 years. Treatment of neck was chosen by a multidisciplinary team, according to age, medical status and availability for regular follow-up. One hundred and ten patients (47%) underwent elective neck dissection (END); 28 (25%) had positive nodes and received neck irradiation post-operatively. One hundred and twenty three patients (53%) were regularly followed up only, with therapeutic neck dissection (TND) reserved for cases of node relapses. In the END group, there were 19 neck relapses (17%): 12/60 (20%) in patients with mobile tongue carcinoma and 7/50 (14%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 9/19 (47%) cases. In the TND group, there were 21 neck relapses (17%): 16/82 (20%) in patients with mobile tongue carcinoma and 5/41 (10%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 13/21 (62%) cases. Ten-year survival is 37% for the END group and 31% for the TND group. Tumour stage and infiltration into underlying tissues increased the probability of neck relapse and death. Furthermore, a multivariate analysis showed that patients treated in the TND group had a higher probability of death than patients treated in the END group (p less than 0.04).     

Interstitial irradiation for carcinoma of the tongue and floor of mouth: Royal Marsden Hospital Experience 1970-1986

One hundred and forty nine patients with carcinoma of the tongue or floor of mouth were treated with interstitial irradiation (+/- external beam therapy) using caesium needles or iridium wires between 1970 and 1986. Multivariate analysis showed the main predictors of outcome to be tumour stage, site and histology. Caesium and iridium techniques gave similarly good local control rates of 90% at 5 years for T1 and T2 tumours when used as the standard departmental method. Local failure was shown to have a major impact on the risk of dying from disease and elective neck irradiation (ENI) conferred a favourable benefit on neck control and survival provided the primary site was controlled. Patients less than 40 years of age appeared to have an unfavourable prognosis. Radical irradiation including interstitial techniques gives excellent results in early oral cancer and is the treatment of choice for T2 tumours. We recommend elective neck irradiation in patients at high risk of developing lymph node metastases.     

Neck node metastasis after successful brachytherapy for early stage tongue carcinoma.

BACKGROUND AND PURPOSE: The accuracy of factors for predicting lymph node metastasis in patients with early-stage (stage I and II) mobile tongue carcinoma and prognostic factors associated with the clinical and pathological findings of lymph node metastasis were examined. MATERIAL AND METHODS: Between 1971 and 1998, 616 patients with early stage mobile tongue carcinoma were treated by brachytherapy with or without external irradiation. Neck lymph node metastasis occurred in a total of 237 cases, and 191 of them were not associated with primary failure. Neck dissection was performed in 169 of these 191 cases, and 16 cases were treated by radiotherapy. A pathological analysis was possible in 159 of the 169 neck dissection cases. RESULTS: There were 88 tongue cancer recurrences, and the incidence of neck metastasis was 38% (191/528) in the cases of primary controlled early tongue carcinoma, and 25% (38/151) and 41% (153/377), in stage-I and -II carcinoma, respectively. Neck metastasis was diagnosed within 12 months in 80% of cases, and within 24 months in 95%. Macroscopic appearance, tumor thickness and tumor length were identified as significant risk factors by a univariate analysis, but macroscopic appearance was the only significant risk factor identified by a multivariate analysis (P<0.001). The incidence of cervical lymph node metastasis was 62% among the invasive/ulcerative type tongue carcinomas, and was lower among the superficial type and exophytic/nodular type (20 and 35%, respectively). Regional and/or distant failure occurred in 75 of the 169 neck dissection cases (44%). The incidence of regional/distant failure was extremely high (49/68=72%) in the extra-nodal invasion group, and extra-nodal invasion was found even in small metastatic node less than 1 cm in length (20%). CONCLUSIONS: The macroscopic appearance of the primary tongue carcinoma has a major impact on the incidence of lymph node metastasis in patients with early tongue cancer, and extra-nodal invasion was the dominant risk factor for regional and distant failure. Treatment policy for clinically negative neck metastasis in early tongue cancer patients should be determined after considering the possibility of neck metastases and the morbidity associated with elective neck dissection.     

Clinical studies on cancer of the tongue

Thirty-nine previously untreated patients with squamous cell carcinoma of the tongue were treated by irradiation or a combination of irradiation and surgery, with or without chemotherapy, between January 1971 and December 1980. All of the patients had a follow-up period of at least nine years. Twenty-two patients were men and 17 were women. The average age was 50.1 years, with a range of 30 to 74 years. The absolute five-year survival rate was 82.1% and the cumulative ten-year survival rate 76.9% for these 39 patients. Cervical node metastases were clinically found on admission in 14 patients whose five-year survival rate was 64.3%, whereas it was 92.0% for 25 patients without metastasis. The absolute five-year survival rate decreased from 92.3% for patients with stage I lesions to 90.9%, 87.5% and 42.9% for those with stage II, stage III and stage IV lesions, respectively. Most of the patients received external irradiation and intraoral electron beam therapy. External irradiation was administered to the upper neck in all but one of 25 patients with TxN0 lesions. Subsequently partial glossectomy was performed in 12 of the 25 patients. Hemiglossectomy and hemimandibulectomy were used for 5 of 16 patients with TxN1-3 lesions. No patients with TxN0 lesions developed neck lymph node metastasis. Twenty-nine of the 39 patients had no tumor recurrence either locally or regionally for five years and 27 for nine years. None of the patients had major post-irradiation complications.     

95例Ⅰ期舌体鳞癌的颈部处理

背景与目的颈淋巴结的转移与复发是舌癌治疗失败的常见原因,目前对早期舌癌的颈部处理仍有争论,本研究旨在探讨选择性颈清扫术在治疗临床Ⅰ期舌体鳞癌中的作用。方法回顾性分析1988年至1997年间手术治疗的95例临床Ⅰ期舌体鳞癌患者,分为颈部观察和选择性颈清扫两组,总结分析选择性颈清扫对颈部复发率、总体生存率等治疗结果的影响。结果行颈部观察组24例,颈部复发率为25.0%(6/24),由于颈部复发而导致的死亡率为20.8%(5/24);行选择性颈清扫组71例,颈部复发率和由于颈部复发而导致的死亡率分别为7.0%(5/71)和4.2%(3/71)。两组的颈部复发率和由于颈部复发而导致的死亡率差异均有显著性(χ2检验,P<0.05);选择性颈清扫组的总体生存率亦显著高于颈部观察组(log鄄rank检验,P<0.05)。结论对临床Ⅰ期舌体鳞癌行选择性颈清扫不但可以提高患者的颈部控制率,而且能减少因颈部复发导致的死亡率,提高患者的总体生存率。     

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.     

The influence of extent of neck treatment upon control of cervical lymphadenopathy in cancers of the oral tongue

This is a retrospective analysis of the management of the neck in 84 patients with squamous cell carcinoma of the oral tongue treated with curative intent between 1968 and 1985. Patients with a clinically negative neck were treated to the neck only if the patient was thought to have a reasonable probability of occult neck metastases. This policy resulted in a 3-year adjusted neck control rate for N0 patients treated with limited (no, bilateral-partial, or ipsilateral) neck therapy of 38% compared with 95% for patients treated with bilateral, whole neck irradiation (p less than .001). None of the relapses in the patients with limited irradiation were in the treatment portal. Attempted salvage with a neck dissection resulted in cure in only 30%. The 3-year adjusted neck control rate for the N1 and N2 patients treated with total neck irradiation and surgery was 75% and 63%, respectively. The location of recurrence in these patients was in the field of irradiation, but contralateral to the side of the neck dissection.     

舌体鳞癌颈淋巴结阴性患者的颈部治疗策略

目的探讨舌体鳞癌N0患者颈部淋巴结治疗方法,以减少临床上的失误或过度治疗.方法对1985至2002年间165例舌体鳞癌N0患者进行回顾性研究.对部分T1、T2及T3期患者切除原发灶,进行颈部观察;其余T2期以上患者或无法随访的T1期者采取选择性颈淋巴清扫,全部病例术后随访3年以上.各组间的比较采用χ2检验.结果 120例行选择性颈淋巴清扫术(END),33例术后病理证实淋巴结转移,45例单纯原发灶切除病例中9例出现颈淋巴转移.淋巴结隐匿性总转移率为25.5%,并随临床T分期的增高而增高.观察组总体颈部失控死亡率(20.0%)与END组(5.0%)相比,差异有显著性(P<0.05).T1期观察组和END组的颈部失控死亡率分别为7.7%和4.0%,两组间差异无显著性(P>0.05);而将T2、T3期作为中期病变合并,观察组(70.0%)和END组(0)差异有显著性(P<0.001).结论舌体鳞癌颈部隐匿性淋巴结转移率随临床T分期的增高而增高,对T2期以上N0舌体鳞癌患者应考虑行选择性颈清扫术,以提高其颈部控制率和生存率;对T1N0患者,如能够严密随访,可考虑单纯局部切除原发灶,以提高生存质量.     

Incidence and control of occult neck node metastases from squamous cell carcinoma of the anterior two-thirds of the tongue

Cervical lymph node metastases developed in 45% of patients with T₁N₀ squamous cell carcinomas of the oral tongue in spite of local control of the primary lesions in 79%. The control rate for the neck of those who converted from a negative to a positive neck (N_oN₊) was 33%. Neck node metastases developed in 49% of patients with T₂N₀ tumors. The control rate of the primary tumor was 32%, and the control rate of the neck of those whose neck nodes converted (N₀N₊) was 16%. Neck node metastases developed in 42% of patients with T₃N₀ tumors. The control rate of the primary tumors was 33%, and the control rate of the neck of those who converted (N₀N₊) was 7%. The development of neck node metastases in patients after treatment of the primary tongue carcinoma is of grave prognostic significance. The use of elective treatment to the neck at initial treatment can prevent metastases in the neck from developing if the primary tumor is under control.     

Interstitial irradiation of carcinoma of the tongue

From 1977 to 1988, 61 patients have received radical treatment for a carcinoma of the mobile tongue. Fifty-nine of these patients were treated in association with a BLM (or PEP), and 26 patients with external irradiation. The local tumor control rate at two years was 77%, and subsequent lymph node metastasis was 25%. The five year cumulative survival rate was 55% and the main causes of death were found to be regional node metastases and other related diseases particularly. The determinate survival for TxN0 tumors was 83%. Six percent and 26% had radio-osteonecrosis and soft tissue necrosis respectively and three patients required surgery.     

舌体鳞癌隐匿性颈淋巴结转移的外科治疗探讨

背景与目的:对于临床颈淋巴结阴性(cN0)的舌癌颈部的处理一直存在争议,本研究旨在探讨cN0舌体鳞癌颈部的合理治疗方案。方法:回顾性分析187例手术前后未行放、化疗的cN0舌体鳞癌初诊患者的临床资料;分析颈部隐匿性淋巴结转移规律和隐匿性淋巴结转移及预后的影响因素,以及颈部不同处理方式的控制情况。结果:隐匿性淋巴结转移率为23.0%,其最常见的位置在同侧颈Ⅱ区,83.0%的隐匿性淋巴结转移分布在同侧颈Ⅰ、Ⅱ、Ⅲ区;病理分级是影响隐匿性淋巴结转移的独立因素;隐匿性淋巴结转移为影响cN0舌癌患者预后的独立因素;肩胛舌骨肌上清扫术的颈部复发率为6.7%。结论:肩胛舌骨肌上颈清扫术是cN0舌体鳞癌患者有效而安全的治疗措施。     

舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响

背景与目的:舌鳞癌隐匿性颈淋巴结转移有一定的规律性,且影响预后。本研究的目的是分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响,为选择性肩胛舌骨肌上颈清扫提供临床依据。方法:收集1990～1996年间在我院住院行手术治疗的164例舌鳞癌患者的资料,分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响。结果:164例舌鳞癌隐匿性颈淋巴结转移率为25.71%,最常见的转移部位是同侧的Ⅱ区,其次分别为同侧的Ⅰ和Ⅲ区,82.98%隐匿性转移的颈淋巴结位于以上3个区域,大多数隐匿性转移的颈淋巴结在首次手术治疗后2年内(33/36)被发现。经统计学分析,显性颈淋巴结转移和隐匿性颈淋巴结转移与无转移组之间患者的预后有显著性差异(log-rank,P<0.01),而显性转移组与隐匿性转移组患者的预后之间无显著性差异(log-rank,P>0.05)。结论:同侧的Ⅰ～Ⅲ区是舌鳞癌隐匿性颈淋巴结转移的常见区域,对较易发生隐匿性颈淋巴结转移的cN0舌鳞癌患者可行选择性肩胛舌骨肌上颈清扫术。隐匿性颈淋巴结转移影响cN0舌鳞癌患者的预后。     

Long-term regional control after radiation therapy and neck dissection for base of tongue carcinoma

: Minimal literature exists with 10-year data on neck control in advanced head and neck cancer. The purpose of this study is to determine long-term regional control for base of tongue carcinoma patients treated with primary radiation therapy plus neck dissection.

: Between 1981–1996, primary radiation therapy was used to treat 68 patients with squamous cell carcinoma of the base of tongue. Neck dissection was added for those who presented with palpable lymph node metastases. The T-stage distribution was T1, 17; T2, 32; T3, 17; and T4, 2. The N-stage distribution was N0, 10; N1, 24; N2a, 6; N2b, 11, N2c, 8; N3, 7; and Nx, 2. Ages ranged from 35 to 77 (median 55 years) among the 59 males and nine females. Therapy generally consisted of initial external beam irradiation to the primary site (54 Gy) and neck (50 Gy). Clinically positive necks were boosted to 60 Gy with external beam irradiation. Three weeks later, the base of tongue was boosted with an Ir-192 interstitial implant (20–30 Gy). A neck dissection was done at the same anesthesia for those who presented with clinically positive necks, even if a complete clinical neck response was achieved with external beam irradiation. Neoadjuvant cisplatin-based chemotherapy was administered to nine patients who would have required a total laryngectomy if their primary tumors had been surgically managed. The median follow-up was 36 months with a ranged from 1 to 151 months. Eleven patients were followed for over 8 years. No patients were lost to follow-up.

: Actuarial 5- and 10-year neck control was 96% overall, 86% after radiation alone, and 100 after radiation plus neck dissection. Pathologically negative neck specimens were observed in 70% of necks dissected after external beam irradiation. The remaining 30% of dissected necks were pathologically positive. These specimens contained multiple positive nodes in 83% despite a 56% overall complete clinical neck response rate to irradiation. Regional failure occurred in only two patients, neither of whom underwent adjuvant neck dissection. Symptomatic neck fibrosis (RTOG grade 3) was not observed. Actuarial 5- and 10-year local control was 88% and 88%, disease-free survival was 80% and 67%, and overall survival was 86% and 52%.

: For base of tongue cancer, most patients can obtain long-term regional control with no severe complications after definitive radiation therapy, plus neck dissection for those who present with lymphadenopathy. Complete clinical regression of palpable neck metastases after irradiation poorly correlates with pathologic outcome. Our current policy is to include neck dissection at the time of implantation for patients who present with palpable neck metastases. We realize that this therapeutic approach may overtreat some patients, but we are reluctant to change our policy in light of these excellent outcomes.     

Management of the node negative early carcinoma tongue

Objective

To determine the role of thickness of the primary lesion in early Squamous Cell Carcinoma (SCC) of the oral tongue for decision-making regarding the management of possible occult cervical node metastases.

Setting

Tertiary referral centre

Patients

Patients who were treated by the authors for early (T1, T2) primary lesions in the oral tongue in two malignancy treatment centres of the Armed Forces Medical Services were included in this prospective study. Where the primary lesion was less than 04 mm in depth, the neck was not addressed electively. Those who developed nodal disease in the neck on follow up were subjected to comprehensive neck dissection. In those patients where the tumour thickness was more than 04 mm, the neck was addressed with at least a supra-omohyoid neck dissection. Postoperative radiotherapy was given as per standard indications. The patients were followed up as per standard protocol.

Results

Disease free survival rate achieved was 86% and this compares well with survival rates achieved by other workers.

Conclusion

Treatment of neck nodes in early (T1,T2) SCC of the oral tongue can be expectant in cases where tumour thickness is less than 04 mm, but where it is more than 04 mm elective treatment of the neck is recommended.     

舌体鳞癌颈淋巴结转移的规律和治疗策略

背景与目的:目前,对临床颈淋巴结阴性(cN0)的舌癌病例是否需行颈淋巴清扫术治疗仍存争议。本研究目的在于探讨舌体鳞癌的颈部淋巴结转移规律和分区性颈淋巴结清扫术应用于cN0舌癌病例的理论依据和应用原则。方法:回顾性分析1991年至1997年214例手术治疗的舌体鳞癌患者的临床资料;分析cN0pN+(病理检查淋巴结阳性)病例和cN+pN+病例的颈部转移淋巴结分布规律;比较不同分组的远期疗效;Cox回归分析法筛选影响舌体鳞癌患者预后的因素。结果:pN+病例69例,颈淋巴结转移率32.2%,其中同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占22.3%、33.5%、22.3%、4.6%、1.0%;对侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占6.6%、3.6%、3.0%、2.0%、0.5%。pN+组和pN0组5年生存率各为47%、83%(P<0.001);Cox回归分析显示影响舌体鳞癌患者预后的独立因素为T分期、N分期。结论:舌体鳞癌淋巴结转移最常见于同侧颈部Ⅰ、Ⅱ、Ⅲ区;分区性颈淋巴结清扫术对cN0病例既可起治疗的作用,又可用于评价颈部淋巴结转移状况以决定是否行全颈淋巴结清扫术。     

The place of brachytherapy in the treatment of carcinoma of the tonsil with lingual extension

One hundred forty-four of 170 patients (85%) were seen with cancer of the tonsil and received radical irradiation between 1959 and 1980. A 39% crude 3-year disease-free survival rate and a 51% locoregional control rate were observed. Locoregional relapse related to T Stage was 6, 43, 58, and 64% for T1, T2, T3, and T4, respectively. Fifty-four of 144 patients (37%) showed tongue extension, 20% in T1-T2 stages and 50% in T3-T4 stages. Local relapse was 64% and the 3-year disease-free survival rate was 23% in 39 patients with tongue extension treated with external irradiation alone, versus 33 and 43% respectively for 90 patients with no tongue extension. The increase of lymph node metastases or neck recurrences was not related to tongue extension. In 15 patients with tongue extension, treated with external radiation plus brachytherapy, the local relapse was 40% and the 3-year survival rate 60%. External irradiation plus brachytherapy was significantly related to lower local relapse and increased survival rate compared to external irradiation alone in cancer of the tonsil with tongue extension. The combined modality was not associated with increased risk of radiation complications.     

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.     

Retrospective study of results of interstitial radiotherapy for cancer of the tongue

Background This retrospective study was carried out to clarify whether interstitial radiotherapy is effective in the management of carcinoma of the tongue. Methods The subjects were 65 previously untreated patients with invasive squamous cell carcinoma of the anterior two-thirds of the tongue who received mainly interstitial radiotherapy using¹³⁷Cs needles with or without external irradiation between 1977 and 1993. Results The local control rate was 80% for T1, 73% for T2, 57% for T3 and 73% overall. Thirteen of 16 patients for whom local control failed achieved good control by salvage surgery. The local control rates were slightly lower with combined radiotherapy (64%) than with the interstitial radiotherapy alone (78%), but there was no significant difference between external radiation (≤30 Gy) and external radiation (>30 Gy). Cervical lymph node metastases developed in 26% of patients with T1-3 NO. Neck control was achieved in 20 (74%) of 27 patients in whom pathologically positive nodes were found. Twenty-two patients developed soft tissue or/and mandibular complications for a total of 28 cases. Soft tissue complications were more likely to occur in patients who received interstitial radiotherapy alone. On the other hand, mandibular complications were likely to occur in patients who received external irradiation. The cumulative 5-year survival rate was 92% for T1, 72% for T2 and 33% for T3. The 5-year survival rate of patients with subsequent cervical node metastases was 41%, whereas in patients without subsequent cervical node metastases it was 89% (P<0.001). Conclusions Interstitial radiotherapy with or without external irradiation has useful implications in the local control of newly diagnosed cases of tongue cancer. If local recurrence develops, it is possible to control the primary lesion and prolong survival by salvage surgery. The most effective treatment modality for neck control and survival could not be determined from this study.     

Elective neck dissection in clinical stage I squamous cell carcinoma of the tongue: Does it improve regional control or survival time?

The objective of this study was to evaluate whether elective neck dissection could improve regional control or survival time in clinical stage I squamous cell carcinoma of the oral tongue (OTSCC). This was a retrospective study of patients with surgical treatment between January 1991 and December 2003. A total of 131 patients were included in the study, and all of them received operation of the primary site, while 88 cases underwent selective neck dissection simultaneously including level I-III neck dissection in 49 patients and level I-V neck dissection in 39 patients. In all these cases, the rate of occult neck metastases was 23.7%. The 4-year local control rates in patients with only primary site treatment, patients with level I-III neck dissection and patients with level I-V neck dissection were 81.0%, 83.6% and 89.1%, respectively. By univariate analyse, neck dissection did not increase regional control rate, disease free survival (DFS) or overall survival (OS). Multivariate analyses showed that neck dissection was not an independent factor for DFS or OS. This study showed that the occult neck metastases rate was 23.7% in clinical stage I OTSCC. Elective neck dissection did not significantly improve regional control, DFS and OS in clinical stage I patients. There is a need for accurate and valid methods to select the patients who would benefit from elective neck treatment.     

肿瘤神经侵犯对早期舌鳞癌预后影响的临床回顾性研究*

目的:探讨肿瘤神经侵犯（perineuralinvasion ,PNI）在早期舌鳞癌术后淋巴结转移和局部复发中的作用。方法:对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2008年6 月至2009年12月间156 例早期舌鳞癌病例筛选分析,分为PNI 阳性组和PNI 阴性组各40例,其年龄、性别、病理分期、临床分期基本相同,分析两组患者术后复发、淋巴结转移和预后与PNI及手术方式的相关性。结果:PNI 阳性患者较PNI 阴性患者术后淋巴结转移率高（P = 0.045）、预后差（P = 0.034）,PNI 阳性患者中严密观察组比同期行颈清扫术组术后淋巴结转移率明显高（P = 0.001）,PNI 对早期舌鳞癌局部复发无明显影响（P = 0.531）。 结论:PNI 阳性患者术后淋巴结转移潜能较阴性患者高,早期舌鳞癌PNI 阳性患者需要行同期颈淋巴结清扫术。