肿瘤侵润方式及手术切缘评估对舌癌患者的意义

The Significance of Pattern of Tumor Invasion and Evaluation of Surgical Margin Status in Patients with Tongue Cancer

目的 :探讨肿瘤侵润方式和手术切缘情况对舌癌患者的意义。方法 :分析 1987年 1月～ 1994年 12月 75例舌癌患者的临床资料 ,以Anneroth等提出的将肿瘤侵润最深处宿主 /肿瘤交界处组织的表现分四型来评估肿瘤不同的恶性程度。观察本组患者手术切缘情况 ,通过统计学方法将资料进行综合分析。结果 :肿瘤侵润 Ⅲ ～ Ⅳ 型患者的生存曲线明显低于 Ⅰ ～Ⅱ型 ;切缘阳性患者较阴性患者更易局部复发 ,但阳性者生存曲线较阴性者无明显下降。结论 :应用Anneroth等的肿瘤侵润分型系统 ,评估肿瘤的恶性程度 ,对舌癌患者预后的判断是重要的指征。手术切缘阳性患者较阴性者更易复发 ,通过术后放疗 。

Objective:To evaluate the significance of pattern of tumor invasion and surgical margin status in patients with tongue cancer.Methods:The clinical materials of 75 cases with tongue cancer treated in the department from Jan.1987to Dec.1994 were retrospectively assessed.The grading of multiple histologic parameters as proposed by Jacobson modified by Anneroth and Bryne et al.was used.The appearance of the host/tumor interface at the deepest point of invasion was evaluated using a four-tiered grading system to describe the different degree of tumor malignancy.The surgical margin status of every case was reviewed.Results:Cumulative survival was significantly lower when patients with grade 3 or 4were compared with those with grade 1or 2.Positive margin had a higher risk of local recurrence than that of negative margin but no significant decrease in cumulative survival.Conclusion:Using the grading system of tumor invasion modified by Anneroth and Byrne et al.for assessing the pattern of invasion at the deepest point of tumor invasion to describe the degree of tumor malignancy,that is an important predictor to assess the prognosis of the patient with tongue cancer.Surgical positive margin has a higher risk of local recurrence than that of negative margin.The survival curve of positive margin may not associate with a significant decrease through an effective adjuvant postoperative radiotherapy.