Muñoz Guerra Mario Fernando, Naval Gías Luis, Campo Francisco Rodríguez, Pérez Jesús Sastre
Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, C/General Ricardos no. 171, 2B, 28025 Madrid, Spain.
J Oral Maxillofac Surg. 2003 Nov;61(11):1289-96. doi: 10.1016/s0278-2391(03)00730-4.
The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the local control and survival after surgical treatment of oral cancer, according to these 2 different mandibular resection procedures.
We conducted a retrospective study of a 20-year cohort of 106 patients who underwent marginal or segmental mandibulectomy for oral cancer. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the floor of the mouth, mandibular gingiva, retromolar trigone, tongue, buccal mucosa, or oropharynx. The type of mandibular resection and treatment outcome were compared, using an univariate analysis by the Pearson chi(2) test, logistic regression model for multivariate analysis, and Kaplan-Meier method to determine survival.
The 5-year observed survival rate was 60.35%. The presence of histologic mandibular invasion increased the local recurrence rate. Early tumor stages (P =.02) were found to be associated with decreased local recurrence rates. Our findings indicate that tumor stage and size of mandibulectomy are more important than the type of mandibulectomy in predicting histologic bone involvement. The cases treated with a greater than 4 cm bone resection showed a lower survival rate than those treated with less than 4 cm mandibulectomy (P =.01). Patients in advanced stages (P =.006) and those with surgical margin (P =.0001) or the bone (P =.003) affected by the tumor showed a statistically significant lower survival rate. However, no statistically significant differences were found between patients treated by marginal or segmental mandibulectomy.
Among the prognostic factors studied, the status of the surgical resection margin, the bony involvement and the size of mandibulectomy affected the prognosis for oral carcinoma. Mandibular conservation surgery is oncologically safe for patients with squamous carcinoma in early stages. The marginal technique was not associated with worse prognosis.
口腔鳞状细胞癌的治疗可能需要进行下颌骨切除以确保足够的切缘。这种骨切除通常是节段性或边缘性下颌骨切除术。本研究的目的是根据这两种不同的下颌骨切除手术方式，评估口腔癌手术治疗后的局部控制情况和生存率。
我们对106例因口腔癌接受边缘性或节段性下颌骨切除术的患者进行了为期20年的回顾性研究。所有患者均经活检确诊为鳞状细胞癌，病变累及口底、下颌牙龈、磨牙后三角、舌、颊黏膜或口咽。采用Pearson卡方检验进行单因素分析、逻辑回归模型进行多因素分析以及Kaplan-Meier法确定生存率，比较下颌骨切除类型和治疗结果。
5年观察生存率为60.35%。组织学上存在下颌骨侵犯会增加局部复发率。发现早期肿瘤阶段（P = 0.02）与局部复发率降低相关。我们的研究结果表明，在预测组织学骨受累方面，肿瘤分期和下颌骨切除范围比下颌骨切除类型更重要。骨切除范围大于4 cm的病例生存率低于骨切除范围小于4 cm的病例（P = 0.01）。晚期患者（P = 0.006）以及手术切缘（P = 0.0001）或骨（P = 0.003）受肿瘤影响的患者生存率在统计学上显著较低。然而，边缘性或节段性下颌骨切除术治疗的患者之间未发现统计学上的显著差异。
在所研究的预后因素中，手术切缘状态、骨受累情况和下颌骨切除范围影响口腔癌的预后。对于早期鳞状细胞癌患者，下颌骨保留手术在肿瘤学上是安全的。边缘性技术与更差的预后无关。
