Nakagawa Tsuneaki, Shibuya Hitoshi, Yoshimura Ryoichi, Miura Masahiko, Okada Norihiko, Kishimoto Seiji, Amagasa Mitsuo, Omura Ken
Department of Radiology, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo, 113-8519, Japan.
Radiother Oncol. 2003 Aug;68(2):129-35. doi: 10.1016/s0167-8140(03)00187-7.
The accuracy of factors for predicting lymph node metastasis in patients with early-stage (stage I and II) mobile tongue carcinoma and prognostic factors associated with the clinical and pathological findings of lymph node metastasis were examined.
Between 1971 and 1998, 616 patients with early stage mobile tongue carcinoma were treated by brachytherapy with or without external irradiation. Neck lymph node metastasis occurred in a total of 237 cases, and 191 of them were not associated with primary failure. Neck dissection was performed in 169 of these 191 cases, and 16 cases were treated by radiotherapy. A pathological analysis was possible in 159 of the 169 neck dissection cases.
There were 88 tongue cancer recurrences, and the incidence of neck metastasis was 38% (191/528) in the cases of primary controlled early tongue carcinoma, and 25% (38/151) and 41% (153/377), in stage-I and -II carcinoma, respectively. Neck metastasis was diagnosed within 12 months in 80% of cases, and within 24 months in 95%. Macroscopic appearance, tumor thickness and tumor length were identified as significant risk factors by a univariate analysis, but macroscopic appearance was the only significant risk factor identified by a multivariate analysis (P<0.001). The incidence of cervical lymph node metastasis was 62% among the invasive/ulcerative type tongue carcinomas, and was lower among the superficial type and exophytic/nodular type (20 and 35%, respectively). Regional and/or distant failure occurred in 75 of the 169 neck dissection cases (44%). The incidence of regional/distant failure was extremely high (49/68=72%) in the extra-nodal invasion group, and extra-nodal invasion was found even in small metastatic node less than 1 cm in length (20%).
The macroscopic appearance of the primary tongue carcinoma has a major impact on the incidence of lymph node metastasis in patients with early tongue cancer, and extra-nodal invasion was the dominant risk factor for regional and distant failure. Treatment policy for clinically negative neck metastasis in early tongue cancer patients should be determined after considering the possibility of neck metastases and the morbidity associated with elective neck dissection.
研究早期（Ⅰ期和Ⅱ期）活动期舌癌患者预测淋巴结转移因素的准确性，以及与淋巴结转移临床和病理表现相关的预后因素。
1971年至1998年间，616例早期活动期舌癌患者接受了近距离放疗，部分联合外照射治疗。共有237例发生颈部淋巴结转移，其中191例与原发灶未控制无关。这191例中有169例行颈部清扫术，16例接受放疗。169例颈部清扫病例中有159例可行病理分析。
有88例舌癌复发，原发灶早期得到控制的舌癌病例中颈部转移发生率为38%（191/528），Ⅰ期和Ⅱ期癌分别为25%（38/151）和41%（153/377）。80%的病例在12个月内诊断出颈部转移，95%在24个月内诊断出。单因素分析确定肉眼外观、肿瘤厚度和肿瘤长度为显著危险因素，但多因素分析确定肉眼外观是唯一显著危险因素（P<0.001）。浸润/溃疡型舌癌颈部淋巴结转移发生率为62%，浅表型和外生/结节型较低（分别为20%和35%）。169例颈部清扫病例中有75例（44%）发生区域和/或远处失败。结外侵犯组区域/远处失败发生率极高（49/68 = 72%），甚至在长度小于1 cm的小转移淋巴结中也发现有结外侵犯（20%）。
原发舌癌的肉眼外观对早期舌癌患者淋巴结转移发生率有重大影响，结外侵犯是区域和远处失败的主要危险因素。早期舌癌患者临床颈部转移阴性的治疗策略应在考虑颈部转移可能性和选择性颈部清扫相关发病率后确定。
