Liao Chun-Ta, Huang Shiang-Fu, Chen I-How, Kang Chung-Jan, Lin Chien-Yu, Fan Kang-Hsing, Wang Hung-Ming, Ng Shu-Hang, Hsueh Chuen, Lee Li-Yu, Lin Chih-Hung, Yen Tzu-Chen
Department of Otorhinolaryngology, Chang Gung University, Taoyuan, Taiwan, Republic of China.
Ann Surg Oncol. 2010 Nov;17(11):2984-91. doi: 10.1245/s10434-010-1174-1. Epub 2010 Jun 22.
We sought to determine the differences in clinical outcome of tongue and buccal carcinomas.
Five-year locoregional control, distant metastasis, and survival rates were examined in 456 patients with tongue cancer and 407 patients with buccal cancer.
Five-year rates for patients with tongue and buccal carcinomas were as follows: local control, 85% and 87% (P = 0.9366); neck control, 81% and 87% (P = 0.0304); distant metastasis, 8% and 14% (P = 0.0052); disease-free survival, 70% and 72% (P = 0.9978); disease-specific survival, 79% and 78% (P = 0.2435), respectively. After stratification according to pathological lymph node status, patients with buccal cancer and pN0/pNx disease (without neck dissection) had a higher 5-year neck control rate than those with tongue cancer (93% versus 86%, P = 0.0115). In contrast, buccal cancer with pN+ disease had a higher 5-year distant metastasis rate compared with tongue cancer (30% versus 18%, P = 0.0231). In pN0/pNx subjects, neck control was predicted by perineural invasion and the absence of neck dissection in tongue cancer, and by poor differentiation in buccal cancer. In pN+ patients, distant metastases were predicted by pT3-4 disease, age at onset ≤40 years, poor differentiation, and pN+ ≥ 5 nodes in tongue cancer, and by poor differentiation and pN+ ≥ 5 nodes in buccal cancer.
There are significant differences in the failure pattern of tongue and buccal carcinomas. Prognostic models for these malignancies should allow stratification of patients for a risk-adapted approach to treatment.
我们试图确定舌癌和颊癌临床结局的差异。
对456例舌癌患者和407例颊癌患者的5年局部区域控制率、远处转移率和生存率进行了检查。
舌癌和颊癌患者的5年率如下：局部控制率分别为85%和87%（P = 0.9366）；颈部控制率分别为81%和87%（P = 0.0304）；远处转移率分别为8%和14%（P = 0.0052）；无病生存率分别为70%和72%（P = 0.9978）；疾病特异性生存率分别为79%和78%（P = 0.2435）。根据病理淋巴结状态分层后，颊癌且pN0/pNx疾病（未行颈部清扫）的患者5年颈部控制率高于舌癌患者（93%对86%，P = 0.0115）。相比之下，pN+疾病的颊癌5年远处转移率高于舌癌（30%对18%，P = 0.0231）。在pN0/pNx受试者中，舌癌的神经周围侵犯和未行颈部清扫以及颊癌的低分化可预测颈部控制情况。在pN+患者中，舌癌的pT3 - 4疾病、发病年龄≤40岁、低分化和pN+≥5个淋巴结以及颊癌的低分化和pN+≥5个淋巴结可预测远处转移。
舌癌和颊癌的失败模式存在显著差异。这些恶性肿瘤的预后模型应允许对患者进行分层，以采取风险适应性治疗方法。
