Department of Otolaryngology, Head & Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Otolaryngol Head Neck Surg. 2011 Apr;144(4):542-8. doi: 10.1177/0194599810394988. Epub 2011 Feb 4.
Regional recurrence is common following surgery for T1/T2 oral tongue squamous cell carcinoma (SCC). Tumor depth >4.0 mm is commonly assigned as an indication for prophylactic neck dissection to improve regional control. Prophylactic neck dissection may detect extracapsular extension, a poor prognostic sign where adjuvant chemotherapy is indicated. The hypothesis in this study is that regional recurrence is a significant problem in 2.1- to 4.0-mm-depth tumors, and detection of extracapsular extension may be important in this group.
Retrospective chart review.
Australian tertiary referral center.
Review of all patients with T1/T2 oral tongue SCC treated surgically between January 1991 and January 2009 (n = 81).
Twenty-nine prophylactic and 5 therapeutic neck dissections followed for a median 34 months (range, 4-132 months). Tumor depths were 0 to 2.0 mm (n = 15), 2.1 to 4.0 mm (n = 18), 4.1 to 7.0 mm (n = 26), and >7.0 mm (n = 22). Tumors 2.1 to 4.0 mm depth had similar rates of occult nodes as 4.1 to 7.0 mm depth (25% vs 20%). Regional recurrence occurred in 31% overall, 44% in tumors 2.1 to 4.0 mm, and 27% in tumors 4.1 to 7.0 mm depth. Prophylactic neck dissection reduced regional recurrence (17% vs 43%, P = .02). Patients with pathologically negative necks had lower rates of regional recurrence than those with occult nodes (9% vs 50%, P < .01). Extracapsular extension increased regional recurrence (43% vs 7%, P = .02), including 25% of dissected necks with tumor depth 2.1 to 4.0 mm.
Regional recurrence is a significant problem in 2.1- to 4.0-mm-depth T1/T2 tongue tumors. Prophylactic neck dissection may improve regional control in patients with adequate primary resection margins and determine need for adjuvant therapies in 2.1- to 4.0-mm-depth tumors.
T1/T2 口腔舌鳞状细胞癌（SCC）术后常发生区域复发。肿瘤深度＞4.0mm 通常被认为是预防性颈部清扫术的指征，以提高区域控制率。预防性颈部清扫术可检测到包膜外扩展，这是一个预后不良的迹象，需要辅助化疗。本研究的假设是，2.1-4.0mm 深度的肿瘤存在显著的区域复发问题，包膜外扩展的检测在该组中可能很重要。
回顾性病历回顾。
澳大利亚三级转诊中心。
对 1991 年 1 月至 2009 年 1 月期间接受手术治疗的 T1/T2 口腔舌 SCC 患者（n=81）进行回顾性分析。
29 例预防性和 5 例治疗性颈部清扫术，中位随访时间为 34 个月（范围：4-132 个月）。肿瘤深度为 0-2.0mm（n=15）、2.1-4.0mm（n=18）、4.1-7.0mm（n=26）和＞7.0mm（n=22）。2.1-4.0mm 深度的肿瘤隐匿性淋巴结的发生率与 4.1-7.0mm 深度的肿瘤相似（25%vs20%）。总复发率为 31%，2.1-4.0mm 深度肿瘤的复发率为 44%，4.1-7.0mm 深度肿瘤的复发率为 27%。预防性颈部清扫术降低了区域复发率（17%vs43%，P=0.02）。病理检查阴性的颈部患者比隐匿性淋巴结患者的区域复发率低（9%vs50%，P＜0.01）。包膜外扩展增加了区域复发率（43%vs7%，P=0.02），包括 25%的 2.1-4.0mm 深度肿瘤的清扫颈部。
2.1-4.0mm 深度 T1/T2 舌肿瘤存在显著的区域复发问题。预防性颈部清扫术可能会提高有足够原发肿瘤切缘的患者的区域控制率，并确定 2.1-4.0mm 深度肿瘤患者辅助治疗的必要性。
