早期舌鳞状细胞癌的疗效分析

Results of stage I and II tongue squamous cell carcinomas treated with different modalities

目的分析不同方法治疗Ⅰ、Ⅱ期舌鳞癌的疗效。方法回顾性分析103例Ⅰ、Ⅱ期舌鳞癌患者，比较单纯手术、单纯放疗和综合治疗（术前或术后放疗）的疗效及其影响因素。结果Ⅰ、Ⅱ期患者的5年生存率分别为82．4％和80．0％（P=0．361），其中单纯手术组、单纯放疗组和综合治疗组的5年生存率分别为90．3％、68．4％和84．0％（P=0．104），局部复发率分别为2．5％、35．7％和5．7％（P〈0．001）。隐匿性淋巴结转移率为23．8％，其中Ⅱ区的转移率（19．0％）最高。局部复发、区域复发是影响患者预后的独立因素，单纯手术即能获得满意的局部控制，而低分化鳞癌易出现区域复发。结论选用单纯手术治疗早期舌癌，如采用择区性颈淋巴清扫术，清扫范围为Ⅰ～Ⅳ区。

Objective To analyze the results of stage I and H tongue squamous cell carcinomas treated with different treatment modalities. Methods The clinical data of 103 patients with stage Ⅰ and Ⅱ primary tongue squamous cell carcinoma treated with surgery or radiotherapy alone or combined modality therapy were reviewed retrospectively. The treatment results were compared by Log-rank test, Kaplan-Meier and Chi square test among three groups： surgery alone （S）, radiotherapy alone （R） and combined modality therapy （surgery plus preoperative or postoperative radiotherapy, R ＋ S/S ＋ R）, and the prognostic factors were also analyzed using Cox regression models. Results The overall 5-year survival rate （OS） was 82.4% for stage I and 80.0% for stage H disease （ P = 0. 361 ）. The 5-year survival rates of S, R and R ＋ S/S ＋ R groups were 90.3%, 68.4%, and 84.0%, respectively （ P = 0. 104 ）. The local recurrence rates of those three groups were 2.5%, 35.7% and 5.7%, respectively （ P 〈 0.001 ）. Occult lymph node metastasis rate was 23.8%, frequently metastasized to level Ⅱ lymph nodes. The patients with poorly differentiated carcinoma were found to have the highest regional recurrence rate. Local and regional recurrence was revealed as an independent prognostic factor. Conclusion Surgery alone can achieve good treatment result for stage Ⅰ and Ⅱ tongue squamous cell carcinomas, and lymph node dissection of level Ⅰ to Ⅳ in the neck is recommended.