Matsuzuka Takashi, Suzuki Masahiro, Saijo Satoshi, Matsui Takamichi, Nomoto Yukio, Ikeda Masakazu, Tada Yasuhiro, Nomoto Mika, Omori Koichi
Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan.
Department of Otolarynogology, Fukushima Medical University School of Medicine, Japan.
Auris Nasus Larynx. 2014 Oct;41(5):475-8. doi: 10.1016/j.anl.2014.05.003. Epub 2014 Jun 7.
To determine the validity of sentinel node navigation surgery (SNNS) in early stage tongue cancer, the occurrence rate of postoperative cervical metastasis (POCM) after lead plate technique (LPT) introduction and survival rates in patients who underwent SNNS were analyzed.
SNNS was performed in 29 patients (stage I: 14, stage II: 15) from 2000 to 2007. Tc-labeled phytate was prepared as a radiotracer a day before SNNS. The sentinel node (SN) was then examined pathologically during surgery. For cases where metastasis in SN was positive, neck dissection was performed. Occurrence of POCM after LPT introduction was compared with that before LPT introduction. 'Wait and see' policy was performed in 52 patients (stage I: 27, stage II: 25) from 1987 to 1999 as a historical control. The observation period of SNNS cases and 'wait and see' policy cases ranged from 10 months to 165 months (median: 91 months) and from 7 months to 268 months (median: 87 months), respectively.
Six of the 29 SNNS cases (21%) were proven metastatic SNs. Before LPT introduction, POCM occurred in 2 of the 15 cases, while we had no occurrences after LPT introduction. The 5-year overall survival rate of the 29 patients who underwent SNNS and the 52 patients with 'wait and see' policy were 96% and 84%, respectively, and there was statistical significance in the two groups (p<0.05).
As the survival rate of the patients with the SNNS tended to be better than that with the 'wait and see' policy in our cases, SNNS could avoid unnecessary neck dissection. SNNS provides useful information regarding decision-making for neck dissection in early stage tongue cancer.
为确定前哨淋巴结导航手术（SNNS）在早期舌癌中的有效性，分析引入铅板技术（LPT）后术后颈部转移（POCM）的发生率以及接受SNNS患者的生存率。
2000年至2007年期间，对29例患者（I期：14例，II期：15例）实施了SNNS。在SNNS前一天制备锝标记的植酸盐作为放射性示踪剂。然后在手术期间对前哨淋巴结（SN）进行病理检查。对于SN中转移呈阳性的病例，进行颈部清扫术。将引入LPT后POCM的发生率与引入LPT前进行比较。作为历史对照，1987年至1999年期间对52例患者（I期：27例，II期：25例）采取了“观察等待”策略。SNNS病例和“观察等待”策略病例的观察期分别为10个月至165个月（中位数：91个月）和7个月至268个月（中位数：87个月）。
29例SNNS病例中有6例（21%）被证实为转移性SN。在引入LPT之前，15例中有2例发生POCM，而引入LPT后未出现POCM。29例行SNNS的患者和52例采取“观察等待”策略的患者的5年总生存率分别为96%和84%，两组之间存在统计学意义（p<0.05）。
在我们的病例中，由于SNNS患者的生存率往往优于“观察等待”策略，SNNS可以避免不必要的颈部清扫术。SNNS为早期舌癌颈部清扫术的决策提供了有用信息。
