ASCO指南解读:“口腔和口咽鳞状细胞癌颈部管理”

Interpretation of ASCO clinical practice guideline:management of the neck in squamous cell carcinoma of the oral cavity and oropharynx issued in 2019

为提供口腔和口咽鳞状细胞癌颈部管理的循证建议,美国临床肿瘤协会(ASCO)成立了专家组,对1990—2018年相关文献进行了分析,包括系统评价、荟萃分析、随机对照试验、前瞻性和回顾性观察对照试验。共纳入124篇,形成2019版指南。该指南设定了6种常见临床情形,其中口腔和口咽鳞状细胞癌各3种。从生存率、疾病控制情况、复发率及生存质量等角度,讨论了高质量颈淋巴清扫术、术后辅助放疗或放化疗、手术或非手术治疗的适应证,以及单独放化疗是否充足等问题,分条依次提出临床治疗建议。对多种慢性病患者、指南的局限性和适用范围也进行了阐述。本文就2019版ASCO指南进行解读,为诊治口腔颌面部肿瘤提供临床指导。

In order to provide evidence-based recommendations on the management of the neck with squamous cell carcinoma of the oral cavity and oropharynx, ASCO convened an expert panel to conduct a literature search, which includ-ed systematic reviews, meta-analysis, randomized controlled trials, and prospective and retrospective comparative observa-tional studies published from 1990 through 2018. The literature search identified 124 relevant studies to inform this 2019 version. Six clinical scenarios were devised: three for oral cavity cancer and three for oropharynx cancer. Outcomes of in-terest included survival, regional disease control, neck recurrence, and quality of life. For the indications of high-quality neck dissection, postoperative radiotherapy or chemoradiotherapy, surgery or non-surgical treatment, the adequacy of ra-diotherapy and chemotherapy alone were discussed. Treatment standards were proposed successively for different clinical cases. Multiple chronic conditions patients,the scope of application and the limitations of this guideline were stated. The2019 version of ASCO guideline was interpreted in this paper, which has certain guiding significance for diagnosis and treatment of the clinical practice of oral and maxillofacial tumors by surgeons.