95例Ⅰ期舌体鳞癌的颈部处理

Neck Management in Oral Tongue Squamous Cell Carcinoma of Stage Ⅰ: a Report of 95 Cases

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。

BACKGROUND & OBJECTIVE: Cervical lymph node metastasis and recurrence are the most common causes of treatment failure to patients with oral tongue carcinoma. The neck management for oral tongue carcinoma of early stages remains controversial. This study was to evaluate the effectiveness of elective neck dissection (END) in treating oral tongue squamous cell carcinoma (SCC) of stage Ⅰ. METHODS: A retrospective analysis of 95 patients with oral tongue SCC of stage Ⅰ, undergone surgical treatment from 1988 through 1997, was performed to determine the impact of END on patients' outcomes,such as regional recurrence,and overall survival. Of the 95 patients, 24 (observation group) did not undergo END, while the rest 71 (END group) underwent END. RESULTS: In observation group, the regional recurrence rate was 25.0% (6/24), and the recurrence-related mortality was 20.8% (5/24). END significantly reduced both the regional recurrence rate and the recurrence-related mortality to 7.0% (5/71) and 4.2% (3/71) respectively (χ2 test, P < 0.05). The overall survival rate of END group was also significantly higher than that of observation group(log-rank test,P < 0.05). CONCLUSION: END may improve the neck control rate of oral tongue SCC of stage Ⅰ, reduce the recurrence-related mortality, and increase the overall survival rate of patients.