Tytor M, Olofsson J, Ledin T, Brunk U, Klintenberg C
Department of Otolaryngology, University Hospital, Linköping, Sweden.
Clin Otolaryngol Allied Sci. 1990 Jun;15(3):235-52. doi: 10.1111/j.1365-2273.1990.tb00781.x.
This retrospective study comprised 176 patients with squamous cell carcinoma of the oral cavity treated at The Linköping University Hospital over a 19-year period. Clinical parameters, microscopic malignancy grading (according to Jakobsson et al. and Glanz and Eichhorn), DNA cytofluorometry, analysis of therapeutic modalities and statistics regarding survival and prognosis are reported. The mean age was 70 years with a male: female ratio of 1.3:1 One hundred and four patients had T1 or T2 tumours and 109 an N0 neck. Cervical lymph node metastases were more frequent in patients with larger tumours (T3 + T4) than in those with smaller (T1 + T2) (P less than 0.01), in tumours with a high malignancy grading compared to those with a low (P less than 0.05) and in DNA non-diploid tumours compared to diploid ones (P less than 0.001). The aneuploid tumours responded better to preoperative radiotherapy than did diploid (P less than 0.01) or polyploid (P less than 0.05) tumours. Eighty-nine per cent of the recurrences occurred within 1 year of initial therapy. Secondary treatment was successful in 15 of 37 (41%) patients in whom the tumour recurred either at the primary site or in regional lymph nodes, but only in 1 of 8 (12%) with recurrences in both locations. Surgery alone or combined with radiotherapy resulted in equivalent survival rates for tumours in stages I and II. In advanced stages combined radiotherapy and surgery gave better survival figures than either modality alone (P less than 0.01; Kaplan-Meier). The presence of lymph node metastases (P less than 0.001), tumour size (P less than 0.01) and tumour ploidy (P less than 0.005) were the only clinical and histological parameters that significantly influenced survival (Cox regression analysis). Twenty-four patients developed a secondary primary malignancy; 21 of these were located in the aerodigestive tract.
这项回顾性研究涵盖了19年间在林雪平大学医院接受治疗的176例口腔鳞状细胞癌患者。报告了临床参数、显微镜下恶性分级（根据雅各布松等人以及格兰兹和艾希霍恩的标准）、DNA细胞荧光光度法、治疗方式分析以及生存和预后统计数据。平均年龄为70岁，男女比例为1.3:1。104例患者患有T1或T2期肿瘤，109例患者颈部淋巴结为N0。与较小肿瘤（T1 + T2）患者相比，较大肿瘤（T3 + T4）患者的颈部淋巴结转移更为频繁（P < 0.01）；与低恶性分级肿瘤相比，高恶性分级肿瘤患者的颈部淋巴结转移更为频繁（P < 0.05）；与二倍体肿瘤相比，DNA非二倍体肿瘤患者的颈部淋巴结转移更为频繁（P < 0.001）。非整倍体肿瘤对术前放疗的反应比对二倍体（P < 0.01）或多倍体（P < 0.05）肿瘤更好。89%的复发发生在初始治疗后的1年内。37例肿瘤在原发部位或区域淋巴结复发的患者中，15例（41%）接受二次治疗取得成功，但在原发部位和区域淋巴结均复发的8例患者中，仅有1例（12%）治疗成功。对于I期和II期肿瘤，单纯手术或手术联合放疗的生存率相当。在晚期，联合放疗和手术的生存率优于单独任何一种治疗方式（P < 0.01；卡普兰 - 迈耶法）。淋巴结转移的存在（P < 0.001）、肿瘤大小（P < 0.01）和肿瘤倍体（P < 0.005）是仅有的对生存有显著影响的临床和组织学参数（Cox回归分析）。24例患者发生了第二原发性恶性肿瘤；其中21例位于气消化道。
