Huang Shiang-Fu, Kang Chung-Jan, Lin Chen-Yu, Fan Kang-Hsing, Yen Tzu-Chen, Wang Hung-Ming, Chen I-How, Liao Chun-Ta, Cheng Ann-Joy, Chang Joseph Tung-Chieh
Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Cancer. 2008 Mar 1;112(5):1066-75. doi: 10.1002/cncr.23278.
The role of elective and therapeutic selective neck dissection in patients with early stage cancer of the oral tongue remains controversial. The purpose was to investigate the role of neck treatment in the management of this condition.
A total of 380 patients with cT1-2N0 oral tongue cancer were retrospectively reviewed. Patients were staged by means of computed tomography (CT) or magnetic resonance imaging (MRI) scans. A total of 324 patients received elective neck dissection (END), whereas 56 participants received observation (OBS). In all, 287 patients received supraomohyoid neck dissection (SOND), whereas 37 patients received modified radical neck dissection (MRND). Overall survival (OS) and neck control rates (NCR) were investigated according to the treatment modality.
In the END group the occult metastasis (OM) rates in cervical lymph nodes were 5.2% for cT1 lesions and 14.6% for cT2 lesion (P = .005). The 5-year OS (P = .029) and NCR rates (P = .001) were significantly better in the END group compared with the OBS group. Patients who received MRND had a better 5-year NCR compared with SOND, albeit not significantly (91.4% vs 85.3%, P = .415). Multivariate analysis showed that END and stage were independent predictors of both NCR and OS.
END should be performed routinely in patients with early-stage oral tongue cancer, even in the presence of negative neck by CT scans and MRI.
选择性颈清扫术和治疗性选择性颈清扫术在早期舌癌患者中的作用仍存在争议。目的是研究颈部治疗在该疾病管理中的作用。
回顾性分析380例cT1-2N0期舌癌患者。通过计算机断层扫描（CT）或磁共振成像（MRI）扫描对患者进行分期。324例患者接受了选择性颈清扫术（END），而56例患者接受了观察（OBS）。总共287例患者接受了肩胛舌骨上颈清扫术（SOND），而37例患者接受了改良根治性颈清扫术（MRND）。根据治疗方式研究总生存率（OS）和颈部控制率（NCR）。
在END组中，cT1病变的颈部淋巴结隐匿性转移（OM）率为5.2%，cT2病变为14.6%（P = 0.005）。与OBS组相比，END组的5年总生存率（P = 0.029）和颈部控制率（P = 0.001）显著更高。接受MRND的患者5年颈部控制率优于SOND，尽管差异不显著（91.4%对85.3%，P = 0.415）。多因素分析表明，END和分期是颈部控制率和总生存率的独立预测因素。
即使CT扫描和MRI显示颈部阴性，早期舌癌患者也应常规进行END。
