Shikama Naoto, Sasaki Shigeru, Nishikawa Atsushi, Koiwai Keiichirou, Yoshino Fuyumi, Hirase Yuichi, Kawakami Rei, Kadoya Masumi, Oguchi Masahiko
Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
Radiology. 2003 Sep;228(3):789-94. doi: 10.1148/radiol.2283012044.
To discover possible risk factors for local-regional recurrence (LRR) following preoperative radiation therapy and curative surgery for head and neck squamous cell carcinoma (SCC) (stage II-IVB).
Clinical records from 1987 to 1999 of 161 patients with head and neck SCC (oral cavity, 80 patients; larynx, 50; hypopharynx, 19; oropharynx, 12) who underwent preoperative radiation therapy and surgery were retrospectively reviewed. One hundred thirty-two (82%) of the patients had stage III or IV cancer. The median radiation dose was 38 Gy.
The 5-year overall survival rate and LRR rate were 58% and 35%, respectively. At multivariate analysis, oral cavity cancer (P =.020), clinical T stage (P =.016), clinical N stage (P =.017), and status of surgical margins (P =.008) emerged as variables that were significantly associated with LRR. The analysis of only those patients with lymph node involvement showed that oral cavity cancer (P =.008), advanced N-stage cancer (P =.045), and long interval between the start of preoperative radiation therapy and surgery (> or =7 weeks) (P =.019) emerged as variables that were significantly associated with LRR.
Oral cavity cancer, advanced T or N stage of disease, and unsatisfactory margins were risk factors for LRR. A long interval (> or =7 weeks) was a risk factor for LRR in patients with lymph node involvement.
探寻头颈部鳞状细胞癌（II-IVB期）术前放疗及根治性手术后局部区域复发（LRR）的可能危险因素。
回顾性分析1987年至1999年161例接受术前放疗及手术的头颈部鳞状细胞癌患者（口腔癌80例、喉癌50例、下咽癌19例、口咽癌12例）的临床记录。132例（82%）患者为III期或IV期癌症。中位放疗剂量为38 Gy。
5年总生存率和LRR率分别为58%和35%。多因素分析显示，口腔癌（P = 0.020）、临床T分期（P = 0.016）、临床N分期（P = 0.017）及手术切缘状态（P = 0.008）是与LRR显著相关的变量。仅对有淋巴结转移的患者进行分析显示，口腔癌（P = 0.008）、N期晚期癌症（P = 0.045）及术前放疗开始至手术的间隔时间长（≥7周）（P = 0.019）是与LRR显著相关的变量。
口腔癌、疾病的T或N期晚期以及切缘不理想是LRR的危险因素。间隔时间长（≥7周）是有淋巴结转移患者发生LRR的危险因素。
