Elective neck dissection or ＂watchful waiting＂： optimal management strategy for early stage NO tongue carcinoma using decision analysis techniques

Background Although tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and ＂watchful waiting＂ remains controversial for patients with early stage NO oral tongue carcinoma. Methods On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value （EV） was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed. Results The results showed that the decision model favored elective neck dissection （EV=0.87）, over ＂watchful waiting＂ （EV=0.77）. One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the ＂watchful waiting＂ group, and a salvage rate threshold value 0.73 for the ＂watchful waiting＂ group. Conclusions These results suggested that elective neck dissection strategy of the neck should be applied for early stage NO oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, ＂watchful waiting＂ strategy would be preferable.     

T3、T4N0声门上型喉癌选择性颈廓清术的必要性

目的：探讨CN0声门上型喉癌进行颈廓清术的必要性。方法：对本院1990年1月至2001年1月共69例CN0声门上型喉癌患者临床资料进行分析，统计隐匿转移率，并依照T分级比较隐匿转移率。根据随访结果，着重分析颈廓清术对T3、T4级病例的术后复发情况的影响。结果：69例CN0隐匿性淋巴结转移率为36．0％，T1、T2、T3、T4两组间的隐匿转移率差异有显著性。T3、T4中行选择性颈廓清者术后的复发率明显低于未行廓清者。T3、T4中22例发生隐(显)性转移，对侧转移为8例，其中原发病灶超过中线为6例。结论：T3、T4N0声门上型喉癌行选择性颈廓清是必要的。选择性颈廓清术明显降低术后复发率。     

颈淋巴廓清根治术治疗舌癌130例

总结了１３０例舌癌颈廓清根治术在舌癌综合治疗中的应用。全部病例进行了术前辅助化疗，然后施行颈廓清根治术。其中６４例全颈廓清，１２例双侧颈上廓清，５４例１侧颈上廓清。手术成功率为９９．２％，５ａ生存率为６１．５％。结果提示，预防性（选择性）颈廓清对早期舌癌的治疗是必要的。     

选择性颈清扫对T1,2N0M0舌癌患者预后影响的Meta分析

目的 评价选择性颈清扫对T1,2NOM0舌癌患者预后的影响。材料与方法 检索国内外已公开发表的关于选择性颈清扫对T1,2N0M0舌癌患者预后影响的对照研究,应用Meta分析进行统计学处理。结果 (1)选择性颈清扫对术后复发的影响：符合标准的文献7篇,总样本数742．其中选择性颈清扫组291人,观察组451人。Meta分析结果：选择性颈清扫组相对于观察组的复发优势比OR=0．41,95％可信区间(0．22,0．75),具有统计学意义。(2)选择性颈清扫对术后生存的影响：符合标准的文献5篇,总样本数614,其中选择性颈清扫组222人,观察组392人。Meta分析结果：选择性颈清扫组相对于观察组的生存优势比OR=1．61,95％可信区间(1．14,2．27),具有统计学意义。结论 选择性颈清扫可减少T1,2N0M0舌癌患者术后的复发并能延长生存期。     

Occult cervical lymph node metastases in 100 consecutive patients with cN0 tongue cancer

Background Squamous cell carcinoma （SCC） of the tongue maxillofacial region. To provide clinical evidence for selective analyzing the characteristics and correlation of factors of occult with SCC of the tongue. is one of the most common cancers in the oral and neck dissection in management of cN0 patients by cervical lymph node metastases （OCLNM） in patients Methods From 2002 to 2006, 100 consecutive patients with SCC of the tongue were reviewed by analyzing the characteristics of OCLNM, diameter of the tumor, T classifications, depth of invasion, forms of growth, pathological grade and degree of differentiation. Results The rate of OCLNM in 100 patients with SCC of the tongue was 22%. The most common region with OCLNM was level Ⅱ in the ipsilateral neck, followed by levels Ⅰ and Ⅲ. There were 51.61% （16/31） of OCLNM in level Ⅱ and 87.10% （27/31） of OCLNM in levels Ⅰ-Ⅲ. There was no significant correlation between the diameter of tumor and OCLNM （P 〉0.05）. OCLNM was statistically significantly correlated with the depth of invasion, forms of growth, pathological grade and degree of differentiation （P 〈0.05）. The rate of occult metastases increased with the increased pathological grade, the decreased degree of differentiation and the increased depth of invasion. Conclusions The most common regions with OCLNM in cN0 patients with SCC of the tongue were levels Ⅰ-Ⅲ in the ipsilateral neck. Supraomohyoid neck dissection should be the elective treatment to the neck in patients with cN0 SCC of the tongue by consideration of the clinical and pathological factors for the depth of invasion, forms of growth, pathological grade, and degree of differentiation.     

两种颈淋结巴清扫术对口腔鳞癌cN_0期患者手术疗效比较:基于国内样本的Meta分析

目的:采用Meta分析方法,综合定量分析国内公开发表的有关国人cN0期口腔鳞癌患者行两种颈淋巴结清扫术的疗效,为cN0期患者颈淋巴结手术处理方式提供参考依据。方法:搜集国内所有公开发表的、随访资料完整、随机性良好的、分别采用肩胛舌骨上颈淋巴结清扫术(supraomohyoid neck dissection,SOND)与根治性颈淋结巴清扫术(radical neck dissection,RND)对cN0期患者手术疗效行对比观察的相关研究。对符合条件的资料行Meta分析,计算两组间淋巴结转移复发的比数比(odds ratio,OR)。结果:在88篇报道中,有6篇符合纳入标准。标本量1 065例,其中SOND组291例,阳性97例;RND组774例,阳性236例。OR=0.87<0.05(SOND/RND),95%CI为(0.60,1.26)。两者差异无统计学意义。结论:SOND与RND对cN0期口腔鳞癌患者的手术疗效无明显差异,SOND可取代RND以提高患者生存质量。     

头颈部鳞癌的基因模块化分析及潜在抗癌药物筛选

目的 利用生物信息学模块化分析方法,筛选头颈部鳞癌中的功能性基因模块,为头颈部鳞癌的研究和治疗提供新的靶点.方法 获取GEO数据库中头颈部鳞癌的全基因组数据(GSE6631)后,利用R语言limma包筛选头颈部鳞癌中差异表达基因.通过STRING数据库,建立头颈部鳞癌中差异表达基因的蛋白-蛋白互作网络.然后,利用Cytoscape软件的MCODE插件筛选头颈部鳞癌中的基因模块.利用DAVID数据库,获得模块功能.最后,挖掘模块基因中的蛋白激酶基因并利用Selleckchem数据库筛选其激酶抑制剂.结果 共筛选出头颈部鳞癌中的差异表达基因929个(P<0.05且|Fold Change|≥2).根据String数据库,发现这些差异基因中共有5588个蛋白质互作对,并据此建立鼻咽癌中的蛋白质互作网络.利用MCODE方法在蛋白质互作网络中共筛选出3个基因模块.GO分析显示这些模块与头颈部鳞癌的关系十分密切,主要包括参与细胞周期、细胞增殖、细胞黏附、细胞凋亡等重要肿瘤细胞活动.3个模块包含3个蛋白激酶基因,即CDK1、CDK4和CDK5,共筛选出调控它们的39个激酶抑制剂,其中20个对头颈部鳞癌的作用还不清楚,具有成为抗癌新药的潜力.结论 头颈部鳞癌中的3个功能性基因模块可能在头颈部鳞癌的发生发展中发挥重要作用,20个激酶抑制剂可能通过调控CDK家族基因来调控头颈部鳞癌的发生发展,这些功能性模块的挖掘和激酶抑制剂的筛选可能为头颈部鳞癌的研究和治疗提供新的靶点.