Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Ann Surg Oncol. 2011 May;18(5):1447-52. doi: 10.1245/s10434-010-1489-y. Epub 2010 Dec 21.
We evaluated the heterogeneity of primary tumor volume (PTV) within tumors of the same pT4a-staged tongue carcinoma and to elucidate the effects of PTV on treatment outcomes in patients with pT4a-staged tongue carcinoma.
Fifty-eight patients with newly diagnosed pT4a-staged tongue carcinoma who received surgery were enrolled onto this study. Magnetic resonance imaging-derived PTV was measured by the summation-of-area technique.
The mean PTV was 24.55 ml, with a range of 5.32 to 119.64 ml. The receiver operating characteristic curve was applied, and the optimal cutoff volume was 23 ml. Large PTV was associated with a significantly poor disease-specific survival (P = 0.010) by the log rank test. The Cox regression model also revealed that large PTV (P = 0.026) and positive lymphatic node metastasis (P = 0.004) were statistically significant in the prognosis of T4a-staged tongue carcinoma.
A substantial variation of PTV was present within the same pT4a-staged tongue carcinoma, and PTV represented an important prognostic factor. In the light of these findings, we suggest that taking the PTV into account in pT4a-staged tongue carcinoma would better refine the newest revised T classification, and the treatment strategies may be different.
我们评估了同一 pT4a 期舌癌肿瘤内原发肿瘤体积（PTV）的异质性，并阐明了 PTV 对 pT4a 期舌癌患者治疗结果的影响。
本研究纳入了 58 例新诊断为 pT4a 期舌癌并接受手术的患者。采用面积总和技术测量磁共振成像衍生的 PTV。
平均 PTV 为 24.55ml，范围为 5.32 至 119.64ml。应用受试者工作特征曲线，最佳截断体积为 23ml。对数秩检验显示，大 PTV 与疾病特异性生存显著不良相关（P=0.010）。Cox 回归模型也显示，大 PTV（P=0.026）和阳性淋巴结转移（P=0.004）是 T4a 期舌癌预后的统计学显著因素。
同一 pT4a 期舌癌内 PTV 存在显著差异，PTV 是一个重要的预后因素。鉴于这些发现，我们建议在 pT4a 期舌癌中考虑 PTV，可以更好地细化最新修订的 T 分类，治疗策略可能也会有所不同。
