Woolgar J A, Rogers S N, Lowe D, Brown J S, Vaughan E D
Oral Pathology Laboratory, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK.
Oral Oncol. 2003 Feb;39(2):130-7. doi: 10.1016/s1368-8375(02)00030-1.
The prognostic significance of extracapsular spread of cervical metastases in oral cancer is still controversial. To investigate the importance of extent of extracapsular spread; the relationship between extracapsular spread and both traditional measures of metastatic disease and clinical/histological features of the primary tumour, and to determine their relative prognostic significance. The survival of 173 patients undergoing radical surgery and simultaneous neck dissection for oral/oropharyngeal squamous cell carcinoma with histologically confirmed nodal metastasis and followed for 2.2-12.3 years is reported and related to pathological features. The most predictive clinical/histopathological features were determined by Cox regression modelling. The 3-year survival probability was similar for patients with macroscopic and only microscopic extracapsular spread (33 and 36%, respectively, compared with 72% for patients with intranodal metastasis). The Cox model showed the most predictive factor was extracapsular spread followed by status of resection margins. Extracapsular spread should be incorporated into pathological staging systems. Even microscopic extracapsular spread is of critical importance and must be sought especially in small-volume metastatic disease.
口腔癌颈部转移灶的包膜外扩散的预后意义仍存在争议。为了研究包膜外扩散程度的重要性；包膜外扩散与转移性疾病的传统指标以及原发肿瘤的临床/组织学特征之间的关系，并确定它们相对的预后意义。报告了173例接受根治性手术并同时行颈部淋巴结清扫术的口腔/口咽鳞状细胞癌患者的生存情况，这些患者经组织学证实有淋巴结转移，随访时间为2.2至12.3年，并将其与病理特征相关联。通过Cox回归模型确定最具预测性的临床/组织病理学特征。有肉眼可见和仅显微镜下可见包膜外扩散的患者3年生存概率相似（分别为33%和36%，而有淋巴结内转移的患者为72%）。Cox模型显示最具预测性的因素是包膜外扩散，其次是切缘状态。包膜外扩散应纳入病理分期系统。即使是显微镜下可见的包膜外扩散也至关重要，尤其在小体积转移性疾病中必须予以查找。
