Song Tao, Bi Nan, Gui Lai, Peng Zhe
Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100144, China.
Chin Med J (Engl). 2008 Sep 5;121(17):1646-50.
Although tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and "watchful waiting" remains controversial for patients with early stage N0 oral tongue carcinoma.
On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value (EV) was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed.
The results showed that the decision model favored elective neck dissection (EV = 0.87), over "watchful waiting" (EV = 0.77). One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the "watchful waiting" group, and a salvage rate threshold value 0.73 for the "watchful waiting" group.
These results suggested that elective neck dissection strategy of the neck should be applied for early stage N0 oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, "watchful waiting" strategy would be preferable.
尽管舌癌是头颈部常见疾病，但对于早期N0期口腔舌癌患者，在选择性颈清扫术和“密切观察等待”之间选择颈部治疗方法仍存在争议。
根据头颈部癌症的现状，创建了一个决策分析模型，以比较早期舌癌的两种治疗策略。根据符合既定标准的文献计算期望值（EV）。进行了敏感性分析。
结果表明，决策模型支持选择性颈清扫术（EV = 0.87），优于“密切观察等待”（EV = 0.77）。单向敏感性分析表明，结果受区域复发、选择性颈清扫术组阈值0.28和“密切观察等待”组阈值0.17以及“密切观察等待”组挽救率阈值0.73的影响。
这些结果表明，对于无临床淋巴结转移的早期N0期口腔舌癌患者，应采用选择性颈清扫术策略。当隐匿性淋巴结转移率低于0.17且挽救率高于0.73时，“密切观察等待”策略更可取。
