Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.
Head Neck. 2014 Mar;36(3):340-51. doi: 10.1002/hed.23293. Epub 2013 Jun 1.
Modest survival rates are published for treatment of oral squamous cell carcinoma (OSCC) using conventional approaches. Few cohort studies are available for transoral resection of OSCC.
Analysis for recurrence, survival, and prognosis of patients with OSCC treated with transoral laser microsurgery (TLM) ± neck dissection was obtained from a prospective database.
Ninety-five patients (71 patients had stages T1-T2 and 24 had stages T3-T4 disease) with minimum follow-up of 24 months met criteria and demonstrated negative margins in 95%. Five-year local control (LC) and disease-specific survival (DSS) were 78% and 76%, respectively. Surgical salvage achieved an absolute final locoregional control of 92%. Immune compromise and final margins were prognostic for LC, whereas T classification, N classification, TNM stage, comorbidity, and perineural invasion were also significant for DSS.
We document a large series of patients with OSCC treated with TLM, incorporating T1 to T4 primaries. A significant proportion of stage III/IV cases demonstrates feasibility of TLM in higher stages, with final margin positivity of 5%, LC greater than 90%, and comparable survival outcomes.
采用传统方法治疗口腔鳞状细胞癌（OSCC）的生存率较低。目前仅有少数关于经口激光微创手术（TLM）±颈清扫术治疗 OSCC 的队列研究。
从前瞻性数据库中分析了接受 TLM±颈清扫术治疗的 OSCC 患者的复发、生存和预后情况。
95 例患者（71 例为 T1-T2 期，24 例为 T3-T4 期）的随访时间至少为 24 个月，均符合标准，且 95%的患者切缘阴性。5 年局部控制率（LC）和疾病特异性生存率（DSS）分别为 78%和 76%。手术挽救治疗实现了绝对最终局部区域控制率为 92%。免疫功能受损和最终切缘状态与 LC 相关，而 T 分期、N 分期、TNM 分期、合并症和神经周围侵犯与 DSS 也显著相关。
我们记录了一组采用 TLM 治疗的大量 OSCC 患者，其中包括 T1 至 T4 期的原发性肿瘤。相当一部分 III/IV 期病例表明 TLM 在更高分期中的可行性，最终切缘阳性率为 5%，LC 大于 90%，且生存结局相当。
