“低危”早期口腔舌癌患者行部分舌切除术和颈清扫术而不接受术后放疗的长期区域性控制和生存：肿瘤厚度的重要性。

Long-term regional control and survival in patients with "low-risk," early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness.

机构信息

Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.

出版信息

Cancer. 2013 Mar 15;119(6):1168-76. doi: 10.1002/cncr.27872. Epub 2012 Nov 26.

DOI:10.1002/cncr.27872

PMID:23184439

Abstract

BACKGROUND

The objectives of this study were to determine the incidence of locoregional failure in patients with low-risk, early stage oral tongue squamous cell cancer (OTSCC) who undergo partial glossectomy and ipsilateral elective neck dissection without receiving postoperative radiation.

METHODS

A combined database of patients with OTSCC who received treatment at Memorial Sloan-Kettering Cancer Center and Princess Margaret Cancer Center from 1985 to 2005 was established. In total, 164 patients with pathologic T1-T2N0 OTSCC who underwent partial glossectomy and ipsilateral elective neck dissection without postoperative radiation were identified. Patient-related, tumor-related, and treatment-related characteristics were recorded. Local recurrence-free survival, regional recurrence-free survival, and disease-specific survival were calculated by the Kaplan-Meier method. Predictors of outcome were analyzed by univariate and multivariate analysis.

RESULTS

At a median follow-up of 66 months (range 1-171 months), the 5-year rates of local recurrence-free survival, regional recurrence-free survival, and disease-specific survival were 89%, 79.9%, and 85.6%, respectively. Regional recurrence was ipsilateral in 61% of patients and contralateral in 39% of patients. The regional recurrence rate was 5.7% for tumors <4 mm and 24% for tumors ≥ 4 mm. Multivariate analysis indicated that tumor thickness was the only independent predictor of neck failure (regional recurrence-free survival, 94% vs 72% [P = .02] for tumors <4 mm vs ≥ 4 mm, respectively). Patients who developed recurrence in the neck had a significantly poorer disease-specific survival compared with those who did not (33% vs 97%; P < .0001).

CONCLUSIONS

Patients with low-risk, pathologic T1-T2N0 OTSCC had a greater than expected rate of neck failure, with contralateral recurrence accounting for close to 40% of recurrences. Failure occurred predominantly in patients who had primary tumors that were ≥ 4 mm thick.

摘要

背景

本研究旨在确定行部分舌切除术和同侧选择性颈清扫术且术后未接受放疗的低危早期口腔舌鳞癌（OTSCC）患者发生局部区域失败的发生率。

方法

建立了 1985 年至 2005 年期间在纪念斯隆-凯特琳癌症中心和玛格丽特公主癌症中心接受治疗的 OTSCC 患者的综合数据库。共确定了 164 例病理 T1-T2N0 OTSCC 患者，这些患者行部分舌切除术和同侧选择性颈清扫术且术后未接受放疗。记录了患者相关、肿瘤相关和治疗相关特征。通过 Kaplan-Meier 法计算局部无复发生存率、区域无复发生存率和疾病特异性生存率。通过单变量和多变量分析分析了预后的预测因素。

结果

在中位随访 66 个月（范围 1-171 个月）期间，5 年局部无复发生存率、区域无复发生存率和疾病特异性生存率分别为 89%、79.9%和 85.6%。同侧区域复发占 61%，对侧区域复发占 39%。肿瘤<4mm 的区域复发率为 5.7%，肿瘤≥4mm 的区域复发率为 24%。多变量分析表明，肿瘤厚度是颈部失败（区域无复发生存率，肿瘤<4mm 为 94%，肿瘤≥4mm 为 72%[P=0.02]）的唯一独立预测因素。与未发生颈部复发的患者相比，发生颈部复发的患者疾病特异性生存率显著降低（33% vs 97%；P<.0001）。