Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Head Neck. 2013 Jul;35(7):999-1006. doi: 10.1002/hed.23071. Epub 2012 Jun 25.
Existing treatment regimens for squamous cell carcinoma (SCC) of the base of tongue (BOT) favor chemoradiation. However, there is a shifting paradigm toward minimally invasive surgery with adjuvant radiotherapy for select tumors. The aim was to report our experience in conventional surgical management with particular focus on T1/T2 tumors, which may be candidates for minimally invasive techniques.
Between 1985 and 2005, 128 patients were treated with primary surgery. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were calculated using Kaplan-Meier method, and predictive factors analyzed by univariate and multivariate analyses.
Five-year OS, DSS, and RFS rates were 60%, 70%, and 61%, respectively. Multivariate analysis showed pathologic T classification and extracapsular extension (ECE) were significant predictors for DSS, whereas T classification remained significant for local recurrence. DSS for T1/T2 tumors ranged from 77% (node-positive) to 84% (node-negative).
T classification and ECE are independent predictors of outcome for BOT SCC. Patients with cT1/T2 tumors had excellent outcome and may be suitable for transoral robotic or endoscopic surgical procedures.
现有的舌根鳞状细胞癌（BOT）治疗方案倾向于放化疗。然而，对于某些肿瘤，微创手术联合辅助放疗的方法正逐渐成为主流。本研究旨在报告我们在常规手术治疗方面的经验，特别关注 T1/T2 肿瘤，这些肿瘤可能是微创技术的候选者。
1985 年至 2005 年间，128 例患者接受了原发性手术治疗。采用 Kaplan-Meier 法计算总生存率（OS）、疾病特异性生存率（DSS）和无复发生存率（RFS），并通过单因素和多因素分析评估预测因素。
5 年 OS、DSS 和 RFS 率分别为 60%、70%和 61%。多因素分析显示病理 T 分类和包膜外侵犯（ECE）是 DSS 的显著预测因素，而 T 分类对局部复发仍有显著影响。T1/T2 肿瘤的 DSS 从淋巴结阳性的 77%到淋巴结阴性的 84%不等。
T 分类和 ECE 是 BOT SCC 预后的独立预测因素。T1/T2 肿瘤患者的预后良好，可能适合接受经口机器人或内镜手术。
