Fakih A R, Rao R S, Borges A M, Patel A R
Tata Memorial Hospital, Bombay, India.
Am J Surg. 1989 Oct;158(4):309-13. doi: 10.1016/0002-9610(89)90122-0.
A prospective, randomized trial was carried out to assess the value of elective versus therapeutic neck dissection in early squamous cell carcinoma of the oral tongue. Disease-free survival (median follow-up 20 months) was 52 percent versus 63 percent in patients who underwent hemiglossectomy alone and those who underwent hemiglossectomy and radical neck dissection, respectively (difference not statistically significant). Patients with a tumor depth of less than 4 mm did significantly better than those with a tumor depth of greater than 4 mm; they were also more likely to have uninvolved nodes at elective radical neck dissection compared with those with a tumor depth of greater than 4 mm. However, when the survival rates of patients in the two treatment groups were compared with respect to a tumor depth of 4 mm, there was no significant difference between the hemiglossectomy and the hemiglossectomy and radical neck dissection groups. A policy of interval elective radical neck dissection only in those with a tumor depth of greater than 4 mm may optimize cure rates and avoid neck dissection in those unlikely to develop neck recurrence.
开展了一项前瞻性随机试验，以评估选择性颈清扫术与治疗性颈清扫术在早期舌鳞状细胞癌中的价值。单纯行半舌切除术的患者与行半舌切除术加根治性颈清扫术的患者的无病生存率（中位随访20个月）分别为52%和63%（差异无统计学意义）。肿瘤深度小于4 mm的患者比肿瘤深度大于4 mm的患者预后明显更好；与肿瘤深度大于4 mm的患者相比，他们在选择性根治性颈清扫术中更有可能没有淋巴结受累。然而，当比较两个治疗组中肿瘤深度为4 mm的患者的生存率时，半舌切除术组与半舌切除术加根治性颈清扫术组之间没有显著差异。仅对肿瘤深度大于4 mm的患者采取间隔选择性根治性颈清扫术的策略，可能会优化治愈率，并避免对那些不太可能发生颈部复发的患者进行颈清扫术。
