早期舌鳞癌的隐匿性淋巴结转移与治疗

Occult neck matastasis and treatment of early oral tongue squamous carcinomas

目的 :研究 18例Ⅰ期和Ⅱ期舌鳞癌的颈部隐匿性转移和挽救治疗的效果。方法 :18例病人以前均未接受过治疗。原发灶经口腔切除 ,并密切随访观察颈部。结果 :手术切缘均呈阴性。 11% (2 18)的病人原发灶处有复发 ,局部控制率是 89% (16 18)。 5 0 % (9 18)的病人在随访期中发现锁骨上淋巴结转移。在原发灶已控制的情况下 ,淋巴结转移率是 44 % (7 16 )。总的五年生存率是 6 7% (12 18)。颈部隐匿性转移的病人五年生存率是 2 7% (3 7)。结论 :舌癌颈部隐匿性转移率较高 ,挽救成功率较低。因此 ,我们建议对早期舌鳞癌应施行选择性颈清扫术或预防性放射治疗 ,以提高生存率。

Purpose:To study occult neck metastasis and the effects of salvage treatment. Methods:18 patients with stage Ⅰ or Ⅱ oral tongue squamous carcinomas had not received previous treatment. The tongue primary was excised via the transoral route and the neck was observed closely during follow-up.Results:The incidence of occult neck matastasis was 44% (7/16). The salvage rate after appearance of nodal matastasis was 27%(3/7).Conclusions:In oral tongue cancers, elective neck treatment should be considered regardless of a small primary and negative neck examination because of the high incidence of occult nodal matastasis and the poor outcome after salvage treatment.