Barry Conor P, Katre Chetan, Papa Elena, Brown James S, Shaw Richard J, Bekiroglu Fazilet, Lowe Derek, Rogers Simon N
Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK.
Br J Oral Maxillofac Surg. 2013 Jan;51(1):30-6. doi: 10.1016/j.bjoms.2012.02.014. Epub 2012 Mar 22.
This study is a review of practice for patients with T1 or T2 squamous cell carcinoma (SCC) of the anterior tongue and floor of the mouth who presented to the regional maxillofacial unit in Liverpool between 1992 and 2007. We examined trends in management and analysed their effects on resection margins, recurrence, and survival. The Liverpool head and neck oncology database was used to identify patients, and to retrieve their clinical, surgical, and pathological data. When data were missing the case notes and pathology records were reviewed. Follow up was taken to January 2011. A total of 382 patients were included. Despite more conservative treatment with closer resection margins (27% in 1992-1995 and 60% in 2004-2007), fewer free flaps (79% in 1992-1995 and 38% in 2004-2007), and less adjuvant radiotherapy (37% in 1992-1995 and 22% in 2004-2007), there has been no significant increase in local recurrence (14% in 1992-1996 and 8% in 2004-2007), and overall survival has not been adversely affected. This is most striking when T1 tumours are considered in isolation with a consistent trend towards fewer clear margins (95% in 1992-1995 and 28% in 2004-2007) and fewer free flaps (53% in 1992-1995 and 11% in 2004-2007). The case mix was similar over the study period. These data support a more conservative approach to the management of early oral cancer.
本研究回顾了1992年至2007年间就诊于利物浦地区颌面科的舌前部和口腔底部T1或T2期鳞状细胞癌（SCC）患者的治疗情况。我们研究了治疗方式的变化趋势，并分析了其对切缘、复发和生存的影响。利用利物浦头颈肿瘤数据库识别患者，并获取其临床、手术和病理数据。数据缺失时，查阅病历和病理记录。随访至2011年1月。共纳入382例患者。尽管治疗更为保守，切缘更窄（1992 - 1995年为27%，2004 - 2007年为60%），游离皮瓣使用更少（1992 - 1995年为79%，2004 - 2007年为38%），辅助放疗更少（1992 - 1995年为37%，2004 - 2007年为22%），但局部复发率并未显著增加（1992 - 1996年为14%，2004 - 2007年为8%），总体生存也未受到不利影响。单独考虑T1肿瘤时，这种情况最为明显，切缘阴性的比例持续下降（1992 - 1995年为95%，2004 - 2007年为28%），游离皮瓣使用也减少（1992 - 1995年为53%，2004 - 2007年为11%）。研究期间病例组合相似。这些数据支持对早期口腔癌采用更保守的治疗方法。
