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。

Clinical significance of perineural invasion among patients with early squamous cell carcinoma of the tongue

Objective:To investigate the effect of perineural invasion (PNI) on patients with early squamous cell carcinoma of the tongue (ESCCT) and the controversial issues related to PNI's effect on loco-regional recurrence, cervical lymph node metastases, and prognosis. Methods:Data of 156 patients with ESCCT were analyzed. Two subgroups comprising 40 patients each were investigated. One was PNI-positive subgroup, and the other subgroup was consisted of patients with PNI-negative carcinomas. These patients had similar histopathological characteristics and were randomly selected from the total number of cases. The relationship among the prevalence of PNI, loco-regional recurrence, cervical lymph node metastases, and prognosis was analyzed. Results:PNI was significantly correlated with high cervical lymph node metastases and poor5-year survival rates (P=0.045 and P=0.034, respectively) but not with local recurrence ( P=0.531). Elective neck dissection was considerably associated with a low risk of regional recurrence among the PNI-positive ESCCT patients ( P=0.001). Conclusion: PNI should be considered as a predictor for high cervical lymph node metastases and poor5-year survival of early tongue squamous cell carcinoma. Elective neck lymph node dissection should be performed among patients with PNI-positive early tongue squamous cell carcinoma.