Division of Laryngology-Head and Neck Surgery, Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2011 May;74(5):220-5. doi: 10.1016/j.jcma.2011.03.007. Epub 2011 Apr 5.
The optimal treatment of base of tongue squamous cell carcinoma (BOTSCC) remains controversial. To optimize treatment planning, this study analyzed the outcomes of patients with BOTSCC treated in Taipei Veterans General Hospital.
Retrospective chart reviews were performed for 107 patients with BOTSCC from January 1990 to December 2004, and 85 patients were included, with a mean follow-up interval of 38 months. Patients were divided into surgical and radiotherapy/chemoradiation therapy (RT/CRT) groups. Potentially significant variables for survival were analyzed.
The 3-year overall survival (OS) and disease-free survival rates were 40% and 37.1%, respectively. No significant differences in the patient and disease characteristics between the surgical (n = 39) and RT/CRT groups (n = 46) were found. Advanced overall stage (p = 0.034), cervical lymph node metastasis (p = 0.007), and regional recurrence (p = 0.024) were poor prognostic factors for OS. In early-stage disease (Stages I and II), the 3-year OS was higher in the surgical group (68.6%) than in the RT/CRT group (37.5%), but the significance was only borderline (p = 0.071). There was no significant difference in the 3-year OS between the patients in the surgical and CT/CRT groups with advanced-stage disease. In the surgical group, lymphovascular permeation (p = 0.015) and soft-tissue involvement (p = 0.01), determined by pathologic examination, were poor prognostic factors for OS. Recurrence occurred in 35 patients (41.2%), with no significant difference in local, regional, or distant control between the surgical and RT/CRT groups.
These findings emphasize the importance of neck disease control in the treatment of BOTSCC. Although currently, RT/CRT is used more frequently, surgery may still have a role in the treatment of early-stage disease. Both surgery with adjuvant therapy and RT/CRT produced equivalent survival rates in the treatment of advanced-stage disease, but the recurrence rate was unsatisfactory. A more effective treatment modality with less early and late toxicity is needed.
舌根鳞状细胞癌（BOTSCC）的最佳治疗方法仍存在争议。为了优化治疗计划，本研究分析了台北荣民总医院治疗的 BOTSCC 患者的治疗结果。
对 1990 年 1 月至 2004 年 12 月期间的 107 例 BOTSCC 患者进行回顾性病历回顾分析，共纳入 85 例患者，平均随访间隔为 38 个月。患者分为手术组和放疗/放化疗组（RT/CRT）。分析了与生存相关的潜在显著变量。
3 年总生存率（OS）和无病生存率分别为 40%和 37.1%。手术组（n=39）和 RT/CRT 组（n=46）在患者和疾病特征方面无显著差异。总体晚期（p=0.034）、颈部淋巴结转移（p=0.007）和区域复发（p=0.024）是 OS 的不良预后因素。在早期疾病（Ⅰ期和Ⅱ期），手术组的 3 年 OS 高于 RT/CRT 组（68.6% vs. 37.5%），但仅为边缘显著（p=0.071）。晚期疾病患者中，手术组和 CT/CRT 组的 3 年 OS 无显著差异。在手术组中，病理检查确定的淋巴管血管浸润（p=0.015）和软组织侵犯（p=0.01）是 OS 的不良预后因素。35 例患者（41.2%）出现复发，手术组和 RT/CRT 组在局部、区域或远处控制方面无显著差异。
这些发现强调了颈部疾病控制在 BOTSCC 治疗中的重要性。尽管目前 RT/CRT 的应用更为频繁，但手术在早期疾病的治疗中仍可能发挥作用。手术加辅助治疗和 RT/CRT 对晚期疾病的治疗产生了相当的生存率，但复发率不理想。需要一种更有效的治疗方法，以减少早期和晚期的毒性。
