舌鳞状细胞癌临床N0颈清扫模式的探讨

目的 探讨舌鳞状细胞癌(简称鳞癌)临床N0(clinical N0，cN0)颈部合理的治疗模式，避免过度治疗和治疗不足。方法 回顾性分析1985年1月-2001年4月cN0舌鳞癌327例的临床病理资料，比较不同治疗方法对颈部控制率的影响，并进行预后和死因分析。结果 全部病例随访3年以上，总的3年生存率为69．7％(228／327)，颈部治疗失败组和颈部控制组的3年生存率分别为39．1％(25／64)和77．2％(203／263)；51．5％(51／99)死亡与颈部治疗失败有关；总的颈部控制率为80．4％(263／327)，采取观察随访、Ⅰ区清扫、Ⅰ Ⅱ区清扫、肩胛舌骨肌上颈清扫术、经典性颈清扫术、功能性颈清扫术的颈部控制率分别为67．5％(27／40)、72．7％(24／33)、60．0％(15／25)、84．9％(45／55)、86．8％(131／151)、84．0％(21／25)，影响颈部控制率的独立因素为颈部治疗方法和术后N分期。结论 颈部控制是cN0舌鳞癌预后的关键因素；舌鳞癌cN0颈部的治疗首选肩胛舌骨肌上颈清扫术；对于术后病理提示有多个淋巴结转移和(或)包膜外侵犯者应考虑术后放疗。

Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck

OBJECTIVE: This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice. METHODS: Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed. RESULTS: Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control. CONCLUSIONS: Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.