Survival in node-positive early oral squamous cell carcinoma: sentinel node biopsy versus elective neck dissection

Patients undergoing sentinel node biopsy (SLNB) for early oral squamous cell carcinoma (OSCC) who harbour occult metastases (pN+ve) may be at greater risk of mortality due to prolonged overall treatment times than those identified as pN+ve on elective neck dissection (ELND). A retrospective comparative survival analysis was therefore undertaken to test this hypothesis. Patients were identified from the South Glasgow multidisciplinary team (MDT) database. Group 1 comprised 38 patients identified as pN+ve, or who were false negative, on sentinel lymph node biopsy (SLNB). Group 2 comprised 146 patients staged pN+ve on ELND. The groups were compared with the Kaplan Meier method and Cox proportional hazards model. In addition, a matched-pair analysis was performed. A unique and specifically designed algorithm was deployed to optimise the pairings. No difference in disease-specific or overall survival was found between the groups. Patients undergoing SLNB as the initial neck staging modality in early OSCC and are identified as pN+ve do not appear to be at a survival disadvantage compared with those staged with ELND.     

Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma

ObjectivesMap regional lymph node metastases for lateralized oral cavity squamous cell carcinoma (OCSCC) and evaluate factors associated with regional metastases and recurrence.Materials and methodsRetrospective cohort study of 715 patients with lateralized OCSCC surgically treated in 1997–2011. Analysis was performed using log-rank, Kaplan-Meier, and multivariable logistic and Cox regression.ResultsRegional metastases were identified in ipsilateral levels IIA (24%), IB (18%), III (13%), V (9%), IV (7%), IA (2%) and IIB (1%) and the contralateral neck (3%). Lymphovascular invasion (LVI) (Hazard Ratio [HR] 2.2, 95% Confidence Interval [CI] 1.2–3.9) and T category (T3 vs. T1: HR 4.1, 95% CI 1.9–9.3; T4 vs. T1: HR 2.3, 95% CI 1.2–4.3) were associated with regional metastases. Most (71%) isolated regional metastatic recurrences were in undissected levels of the neck, including 58% in levels IV and V. Tumors of the hard palate (HR 4.3, 95% CI 1.2–16.1), upper alveolus (HR 3.2, 95% CI 1.0–4.7) or with LVI (HR 2.0, 95% CI 1.0–3.9) were associated with isolated regional recurrence. For upper alveolar/hard palate tumors, depth of invasion (DOI) ≥4 mm (P = .003) and LVI (P = .04) were associated with regional metastases.ConclusionsFor lateralized OCSCC, elective neck dissection of level IIB or the contralateral neck may rarely be needed, but additional surgical or radiation treatment of levels IV and V may be considered based on patient risk factors, including T category 3–4 or LVI. For upper alveolar/hard palate tumors, DOI ≥4 mm is an appropriate threshold for elective neck dissection.     

超高分辨率眼前节光学相干断层成像技术在结膜增生性疾病诊断中的应用

目的 探讨超高分辨率眼前节OCT在结膜增生性疾病诊断中的应用效果。方法 选取2017年1月～2018年12月浙江大学附属第一医院及北仑分院眼科门诊收治的150例(150眼)结膜增生性疾病患者作为研究组。另选同期在我院进行体检的结膜正常者80例(80眼)作为对照组。统计分析超高分辨率眼前节OCT在睑裂斑,翼状胬肉及鳞状上皮瘤等结膜增生性疾病中临床诊断与病理诊断的符合率。观察分析睑裂斑,翼状胬肉及鳞状上皮瘤等结膜增生性疾病的特征性表现。结果 150例(150眼)结膜增生患者临床诊断为睑裂斑患者30例(30眼),翼状胬肉患者100例(100眼),以及眼表鳞状细胞瘤的患者20例(20眼)。与病理学诊断相比,UHR-OCT诊断睑裂斑诊断符合率为100.00%(30/30),翼状胬肉诊断符合率100.00%(98/98),眼表鳞状细胞瘤诊断符合率为90.91%(20/22),经统计学处理,差异无统计学意义(P0.05)。睑裂斑患者图像特征:生长在角巩膜缘处停止,且角膜上未见隆起,与前弹力层间未见高反射信号,与巩膜间未见明显分界。翼状胬肉患者图像特征:结膜上皮厚度轻度增厚,上皮层表现为中等程度的高反射,角膜上皮与前弹力层间表现为较高程度的高反射信号。OSSN患者图像特征:结膜上皮增厚,呈高反射,结膜正常上皮与异常上皮转变突然,无过渡区域,深部组织间上皮内可见瘤变。结论 超高分辨率眼前节OCT在结膜增生性疾病的诊断中具有较高的准确性,且影像特征明显,具有广阔的临床应用前景。     

皮肤鳞状细胞癌中p53、bcl-2和c-myc的表达及意义

目的 研究p53、bcl—2和c—myc在皮肤鳞状细胞癌中的异常表达及其与癌分化程度的关系。方法 应用免疫组织化学S-P法检测58例皮肤鳞状细胞癌中p53、bcl—2和c—myc的表达水平。结果 58例皮肤鳞状细胞癌中p53、bcl-2和c—myc的阳性表达率分别为48．3％、67．2％和32．8％。结论 p53、bcl—2和c—myc异常表达在皮肤鳞状细胞癌的发生、发展中起重要作用，并与皮肤癌的恶性程度有关。     

雌激素受体在肺腺癌和鳞状细胞癌中的表达研究

目的 研究雌激素受体(ER)a和β在良性肺组织和肺癌组织中的表达及其与临床和病理学特征的关系。方法 采用免疫组织化学方法检测ERa和β在18例肺腺癌和29例肺鳞状细胞癌(共有35例含癌旁肺组织)及12例良性肺病变组织中的表达。切片内阳性细胞数≥20％为ER阳性。结果 ERβ在肺癌组织中的表达主要定位于细胞核，其在肺癌组织中的表达率为44．7％(21／47)，而在癌旁肺组织和肺良性病变组织中无明显表达。ERβ在鳞状细胞癌、腺癌中阳性表达率分别为27．6％(8／29)、72．2％(13／18)，腺癌组织中ERβ表达率显著高于鳞癌(P＜0．05)。ERβ在肺癌、癌旁肺组织和肺良性病变组织中均未见表达。结论 结果提示雌激素受体ERβ与肺癌尤其是肺腺癌的发生可能有关联。     

人口腔鳞癌演变过程中HLA-DR表达改变的研究

目的 :观察HLA DR在口腔鳞癌发生、发展过程中表达的改变并探讨其临床意义。方法 :采用免疫组织化学的方法检测了 2 6例正常口腔黏膜、8例口腔黏膜白斑、3 2例口腔鳞癌原发灶及 15例颈淋巴结转移灶标本内HLA DR的表达。结果 :口腔鳞癌原发灶与正常口腔黏膜HLA DR的表达存在有显著性差异 (P <0 .0 5) ,其余各组间未见有此差异 ;鳞癌原发灶HLA DR的表达除与局部淋巴细胞浸润有显著性关系外与其余各临床病理资料间均无明显关系。结论 :HLA DR在口腔鳞癌细胞中存在有表达异常增高的现象但并不能作为独立的预后判断因素