影响口底癌疗效的相关因素分析

Analysis of the related factors influencing the results of treatment for the floor-of-mouth carcinoma

口底癌在口腔鳞癌手术治疗中具有挑战性,该区解剖复杂、手术入路受限、切缘阳性率较高、常发生双侧颈淋巴结转移。虽然TNM分期系统常用于制定手术计划,但肿瘤的其他病理特点(浸润深度、肿瘤浸润方式、阳性淋巴结比等)亦有助于指导治疗决策以及预后评估。累及范围较广泛的肿瘤,间室外科或拉通术可明显改善局部-区域控制率。切缘>5 mm病例术后局部控制率和生存率较高。与下颌骨紧贴或浅层侵蚀的口底癌,边缘性下颌骨切除术是安全有效的。早期口底癌可发生隐匿性淋巴结转移,但是否行选择性颈淋巴清扫术尚无一致意见;由于Ⅳ、Ⅴ区很少发生转移,因此常采用肩胛舌骨上颈清术。局部晚期的病变,常发生多个淋巴结转移、包膜外扩展、神经浸润以及切缘阳性,术后放疗可提高局部控制率和生存率。

Squamous cell carcinoma of the floor of the mouth(SCCFM)is a challenge in surgical treatment due to the complex anatomy,limited surgical access,high risk of positive margins,and liability to have bilateral cervical metastases.Although TNM staging systems have proven to be important for operative decision making,additional pathological features of oral carcinoma(depth of invasion,the pattern of invasion,positive lymph node ratio and others)help to guide treatment decisions and prognosis assessment.The compartmental surgery approach or pull-through technique can greatly enhance local and regional controls in tumors involving a broader region.The rate of survival and loco-regional control is higher with margins being 5 mm or greater.In the management of SCCFM that abut or minimally erode the mandible without gross invasion,marginal mandibulectomy is safe and effective.Occult metastasis of cervical lymph nodes can occur at the early stage of SCCFM,but the application of elective neck dissection has been controversial.Due to the low rate of positive nodes observed at levelⅣandⅤ,supraomohyoid neck dissection is often used.Postoperative radiation therapy can be used for locally advanced disease,with multiple lymph nodes,perineural invasion,extranodal extension,and positive margins,which can improve loco-reginal control and survival.