早期舌鳞癌颈淋巴转移的规律及评估因素研究进展

Research progress on the consistency and evaluation factors of cervical lymphatic metastasis in early tongue cancer

早期舌鳞癌易发生隐匿性淋巴转移,因此早期舌鳞癌是否进行颈淋巴清扫一直是众多学者争议的问题。为了准确评估患者颈部情况,确定是否同期进行颈淋巴清扫,本文就性别、年龄、原发灶部位、术前辅助检查、浸润深度、病理分级、神经以及血管淋巴管浸润等评估因素进行综述。文献复习结果表明,早期舌鳞癌颈淋巴主要回流至Ⅰ、Ⅱ、Ⅲ区,跳跃性转移较为罕见,早期舌鳞癌的颈淋巴转移主要受浸润深度、病理分级、神经浸润、血管淋巴管浸润等因素影响,为了使早期舌鳞癌患者获得较高的生存率,对于术前通过超声或磁共振成像(magnetic resonance imaging,MRI)显示肿瘤浸润深度超过5 mm、病理分级高、已经存在麻木或者疼痛等临床症状的患者以及在冰冻结果中已存在神经、血管淋巴管浸润的T1期和T2期患者,应考虑切除原发灶同时行选择性颈淋巴清扫。

Early tongue cancer is more prone to occult lymphatic metastasis than other oral cancers.Therefore,the decision of whether to perform neck dissection in the early stage of tongue cancer has been a controversial issue among many scholars.To accurately evaluate the neck condition of patients and determine whether neck dissection should be performed,this article reviews evaluation factors such as sex,age,tumor site,preoperative auxiliary examination results,depth of invasion,pathological grade,and nerve,lymphatic and vascular invasion.A literature review showed that the cervical lymphatics of early tongue cancer mainly migrated to regionsⅠ,ⅡandⅢ,and distant metastasis was rare.The cervical lymphatics of early tongue cancer were mainly affected by the depth of invasion,pathological grade,and nerve,lymphatic and vascular invasion.To achieve a high survival rate for patients with early tongue cancer,patients with preoperative ultrasound or MRI showing a tumor invasion depth of more than 5 mm,a tumor with a higher patholog ical grade,and clinical symptoms such as numbness or pain who are in stage T1 and T2 and who have already have nerve and vascular lymphatic infiltration according to the frozen sectioning results should be considered for primary si multaneous cervical lymphatic dissection.