125例cT1-2N0舌鳞癌治疗后复发的相关因素分析

Postoperative Recurrence-related Factors of 125 Patients with cT1-2N0 Squamous Cell Carcinoma of the Oral Tongue

背景与目的:cT1-2N0舌鳞癌的治疗存在颇多争议,且术后复发率较高,挽救性治疗的成功率低。本研究旨在探讨cT1-2N0舌鳞癌治疗后复发的相关因素,及诸因素对生存率的影响,以指导临床选择更合理的治疗方法。方法:回顾性分析中山大学肿瘤防治中心1992年1月至2000年12月收治的125例cT1-2N0期舌鳞癌患者的临床资料(T158例和T267例),所有患者的治疗方式以手术为主,17例(13.6%)只行原发灶手术,53例(42.4%)行原发灶手术加选择性颈清扫,55例(44.0%)行综合治疗。x2检验和Cox模型分析性别、病程、生长方式、肿瘤部位、分化程度、TNM分期、隐匿性颈淋巴结转移、浸润深度、颈部处理、治疗方案、手术方式与复发、预后的关系。结果:125例患者有41例复发,总复发率是32.8%。总的5年生存率为62.59%,复发组与未复发组的5年生存率分别为38.74%、74.69%,两组比较有统计学意义(log-rank=19.27,P<0.001)。经统计学分析显示,cT1-2N0舌癌的复发与病程((2检验,P=0.002)、生长方式(x2检验,P<0.001)、颈部处理((2检验,P<0.001)、隐匿性颈淋巴结转移(x2检验,P=0.040)显著相关。舌癌的预后与浸润深度(Cox回归,P=0.005)和复发部位(Cox回归,P<0.001)有显著相关性。结论:病程、生长方式、颈部处理和隐匿性淋巴结转移是cT1-2N0舌癌复发的重要因素。浸润深度和复发部位是影响预后的重要因素。

BACKGROUND ＆ OBJECTIVE： The treatment pattern for cT1-2N0 squamous cell carcinoma （SCC） of the oral tongue is controversial; the postoperative recurrence rate of the disease is high and the salvage effect is poor. This study was to explore the postoperative recurrence-related factors of cT1-2N0 SCC of the oral tongue, to analyze their effects on the survival, and to seek more reasonable therapeutic modality. METHODS. Clinical data of 125 patients with cT1-2N0 SCC of the oral tongue, treated in Cancer Center of Sun Yat-sen University from Jan, 1992 to Dec. 2000, were reviewed. Of the 125 patients, 58 were at stage T1, 67 were at stage T2; 17 （13.6%） were treated with local operation alone, 53 （42.4%） were treated with both local operation and selective neck dissection, and 55 （44.0%） were treated with operation and chemotherapy and/or radiotherapy. The correlations of disease duration, tumor growth pattern, clinical TNM stage, pathologic grade, occult cervical lymphatic metastasis, tumor invasion depth, treatment methods and neck management to tumor recurrence and prognosis were analyzed. RESULTS： Forty-one （32.8%） patients had recurrence; the overall 5-year survival rate was 62.59%. The 5-year survival rate was significantly lower in recurrent group than in non-recurrent group （38.74% vs. 74.69%, Iog-rank=19.27, P〈0.001）. Disease duration （X2 test, P=0.002）, tumor growth pattern （X2 test, P〈0.001）, neck management （X2 test, P〈0.001） and occult cervical lymphatic metastasis （Cox regression, P=0.001） were significantly related to the recurrence of cT1-2N0 SCC of the oral tongue. Tumor invasion depth （Cox regression, P=0.005） and the site of recurrent tumor （Cox regression, P〈0,001） were significantly related to the prognosis of cT1-2N0 SCC of the oral tongue. CONCLUSION： Disease duration, tumor growth pattern, neck management, and occult cervical lymphatic metastasis are main recurrent factors of cT1-2N0 SCC of the oral tongue; tumor invasion depth and the site of recurrent tumor are important prognostic factors.