Hitter A, Soriano E, Bettega G, Karkas A, Reyt E, Righini C A
CHU A. Michallon, Clinique ORL, Pôle Tête et Cou et Chirurgie Réparatrice, 38043 Grenoble 09, France.
Rev Laryngol Otol Rhinol (Bord). 2007;128(3):155-62.
The aims of this study were to evaluate the therapeutic outcome and morbidity associated with management of squamous cell carcinoma (SCC) T3-T4 of the floor of the mouth.
This was a retrospective study (1993 and 2005). Inclusion criteria were: 1) Presence of a locally advanced (T3-T4) lesion of the floor of the mouth; 2) Pathological confirmation of SCC; 3) No previous treatment of the floor of the mouth; 4) Absence of any synchronous lesions at the primary endoscopic work-up; 5) Absence of distant metastasis outside the aero-digestive tract; 6) Karnofsky performance index > 70. All patients were treated by surgery and adjuvant radiotherapy. The statistical analysis was conducted using the stat-view software; categorical variables were compared using the Fisher's exact test; analysis of recurrence-free survival rate was done following the Kaplan-Meier method, and the log-rank test was used for the comparison of survival graphs.
Fourty-seven patients were included in this study (42 men), of a mean age of 53.3 years. The majority of patients (93.6%) presented with a stage IVa tumour and no clinical evidence of cervical lymphadenopathy in 60% of cases. All patients underwent bilateral neck dissection adapted to the cervical lymph node status. Forty-one (87%) patients underwent partial mandibulectomy with fibula free-flap reconstruction in 32 cases (78%). Early local complication rate was of 32%. The mean duration of hospitalization was 34 days. Late local complication rate was of 17%. The immediate post-operative death rate was 2%. The rate of survival and recurrence free survival was of 47.5% and 47% respectively. The 3 survival-influencing factors were age (p = 0.02), margins of surgical resection (p = 0.002), and histologic cervical lymph node status (p = 0.03).
T3-T4 tumours of the floor of the mouth are managed by surgical resection and adjuvant radiotherapy. There is a high rate of treatment-associated complications. The prognosis of locally advanced tumours of the floor of the mouth remains humble.
本研究旨在评估口底鳞状细胞癌（SCC）T3 - T4期的治疗效果及相关发病率。
这是一项回顾性研究（1993年至2005年）。纳入标准为：1）存在口底局部晚期（T3 - T4）病变；2）SCC的病理确诊；3）口底此前未接受过治疗；4）初次内镜检查时无任何同步病变；5）无气道消化道外远处转移；6）卡氏评分＞70。所有患者均接受手术及辅助放疗。使用Stat-View软件进行统计分析；分类变量采用Fisher精确检验进行比较；无复发生存率分析采用Kaplan-Meier方法，生存曲线比较采用对数秩检验。
本研究纳入47例患者（42例男性），平均年龄53.3岁。大多数患者（93.6%）为IVa期肿瘤，60%的病例无颈部淋巴结肿大的临床证据。所有患者均根据颈部淋巴结状况进行双侧颈清扫术。41例（87%）患者接受了部分下颌骨切除术，其中32例（78%）采用游离腓骨瓣重建。早期局部并发症发生率为32%。平均住院时间为34天。晚期局部并发症发生率为17%。术后即刻死亡率为2%。生存率和无复发生存率分别为47.5%和47%。3个影响生存的因素为年龄（p = 0.02）、手术切缘（p = 0.002）和颈部淋巴结组织学状态（p = 0.03）。
口底T3 - T4期肿瘤采用手术切除及辅助放疗进行治疗。治疗相关并发症发生率较高。口底局部晚期肿瘤的预后仍然不佳。
