舌鳞状细胞癌浸润深度对颈淋巴结转移及预后的预测价值

Predictive Value of Depth of Invasion of Tongue Squamous Cell Carcinoma for Cervical Lymph Node Metastasis and Prognosis

目的探讨舌鳞状细胞癌(TSCC)浸润深度预测颈淋巴结转移和预后的价值。方法回顾性分析73例T_(1/2)期TSCC患者的临床和病理资料,ROC曲线确定预测颈淋巴结转移的TSCC浸润深度最佳截断值,Logistic回归分析影响淋巴结转移的相关因素,Kaplan-Meier法和Cox回归法进行生存分析。结果73例患者中颈淋巴结转移率24.7%(18/73),中位浸润深度8.00 mm;无淋巴结转移患者55例,中位浸润深度为5.00 mm,两者比较差异有统计学意义(P=0.003)。浸润深度最佳截断值为6.15 mm,AUC=0.75(95%CI:64.1%~87.1%,P=0.001),敏感度为77.8%,特异性为63.6%。多因素分析显示浸润深度和病理分化程度是影响颈淋巴结转移的独立危险因素;浸润深度、神经侵犯和病理分化程度是影响TSCC患者预后的独立危险因素。结论TSCC患者的浸润深度对颈淋巴结转移和预后有重要的预测价值,浸润深度>6.15 mm时应选择颈部淋巴结清扫以提高患者的生存率和减少复发率。

Objective To investigate the predictive value of depth of invasion(DOI)of tongue squamous cell carcinoma(TSCC)for cervical lymph node metastasis and prognosis.Methods We retrospectively analyzed the clinical and pathological data of 73 patients with T_(1/2) TSCC.ROC curve was used to determine the optimal cut-off value of DOI for predicting cervical lymph node metastasis,and logistic regression analysis was performed to analyze the related factors affecting cervical lymph node metastasis of TSCC.Kaplan-Meier method and Cox regression analysis were used for survival analysis.Results Among 73 patients,18 patients were with lymph node metastasis and 55 patients were without lymph node metastasis.The median DOI with and without lymph node metastasis were 8.00 and 5.00 mm,respectively(P=0.003).The optimal cut-off value for DOI was 6.15 mm,with AUC 0.75(95%CI:64.1%~87.1%,P=0.001),sensitivity 77.8%and specificity 63.6%.DOI and pathological differentiation were independent prognostic factors for cervical lymph node metastasis in multivariate analysis.DOI,nerve invasion and pathological differentiation were independent prognostic factors of survival in Cox regression analysis.Conclusion DOI of TSCC patients has important predictive value for both cervical lymph node metastasis and prognosis.Neck lymph node dissection is recommended for patients with DOI>6.15 mm to improve survival rate and reduce recurrence rate.