影响早期舌癌预后的因素及颈部的治疗

Prognostic factors of early tongue squamous cell carcinoma and neck treatment

目的 分析早期舌体鳞癌的预后相关因素及颈淋巴处理方式对生存率的影响,探讨早期舌癌的颈部治疗策略.方法 回顾性分析1994年1月至2003年12月期间152例经手术治疗的早期舌癌患者的临床及随访资料,任意分为颈部观察组与颈清扫组两大组,其中颈清扫组分为肩胛舌骨肌上清扫组和全颈清扫组（即全颈清扫和改良颈清扫）.分析早期舌癌预后的临床病理因素和颈部治疗与否及不同的颈淋巴处理方式对颈部复发转移和生存率的影响.结果 全组病例随访5年以上或至患者死亡,5年随访率为94.7%.颈部观察组32例与颈清扫组120例的颈部复发率分别为34.4%和14.2%,差异有统计学意义（χ2=6.865,P〈0.01）;Kaplan-Meier法统计5年生存率分别为68%和79%,差异无统计意义（χ2=1.699,P〉0.05）.肩胛舌骨肌上清扫组与全颈清扫组的颈部转移复发率及5年生存率差异均无统计学意义（P值均〉0.05）.病理诊断有淋巴结转移和治疗后颈部复发转移患者的5年生存率明显低于无淋巴结转移和治疗后无颈部复发转移者,差异均有统计学意义（P值均〈0.01）.结论 隐匿性淋巴转移和复发是影响早期舌癌预后最主要的因素.肩胛舌骨肌上淋巴清扫虽然不能提高5年生存率,但能明显地降低颈部复发率.鉴于早期舌癌的隐匿性高且颈部复发挽救率低,建议对未过中线的早期舌癌应行同侧Ⅰ、Ⅱ、Ⅲ区的清扫,以减少颈部复发率.

ZHONG Wai-sheng（State Key Laboratory of Oncology in Southern China, Department of Head and Neck, Cancer Center, San Yat-sen University, Guangzhou 510060,Objective To analyse the prognostic factors and the neck treatment strategy of early tongue squamous cell carcinoma （SCC）. Methods Total of 152 cases of early tongue SCC underwent surgery between January 1994 December 2003 were reviewed. The patients, according to their neck managements, were divided into two groups, or wait-whach group （n = 32） and neck dissection group （n =120） ,and the neck dissection group was subdivided into supraomohyoid neck dissection （SND） group and comprehensive neck dissection（CND） group （including radical neck dissection and modified radical neck disssection）. Results All patients were followed up over 5 years or until death and the 5-year follow-up rate was 94. 7%. The regional recurrence rates of wait-whach group and neck dissection group were 34. 4% and 14. 2% respectively （χ2 = 6. 865, P 〈 0. 01） and 5-year overall survival rates of the two groups were 68% and 79% respectively （χ2 = 1. 699, P 〉 0. 05）. There were no significant difference in the regional recurrence rate or 5-year survival rate between SND group and CND group （P 〉 0. 05）. The patients with pathologically node positive had a low 5-year survival rate compared to those with node negative. The patients with regional recurrence had a significant low 5-year survival rate compared to patients without regional recurrence （P〈0.01）. Conclusions Occult lymph node metastasis and regional recurrence were important prognostic factors for early tongue cancer. Supraomohyoid neck dissection can not improve the 5-year survival rate, but significantly reduce the rate of neck recurrence. The results suggest that the selective neck dissection for ipsilateral level Ⅰ - Ⅲ should be applied to the patients with early tongue carcinoma which does not cross the midline.