Hakeem Arsheed Hussain, Pradhan Sultan Ahmed, Kannan Rajan, Tubachi Jagadish
Department of Surgical Oncology, Prince Aly Khan Hospital, Mazagaon, Mumbai, Maharashtra, India.
Ann Maxillofac Surg. 2016 Jul-Dec;6(2):235-240. doi: 10.4103/2231-0746.200331.
To analyze various demographic, clinical, and histopathologic factors in T1-2 N0 squamous cell carcinoma (SCC) of the oral tongue to define a high-risk group for regional recurrence that will benefit from elective neck dissection.
Retrospective outcome analysis of a patient cohort without palpable or ultrasound (USG) detectable nodal metastases undergoing per oral wide glossectomy for T1-2 N0 SCC of oral tongue. Patients were followed up using palpation and serial USG neck and fine-needle aspiration cytology.
Of the 176 patients, 69 (39%) showed recurrence during follow-up. Fifty-eight cases developed regional neck node metastases, i.e., overall regional node recurrence rate of 33%. Fifty-three (91%) with regional neck node metastases were salvaged successfully with further treatment. In 110 cases with tumor thickness more than 5 mm, 39% cases developed regional neck node metastases. This association was significant with = 0.0402. Among 44 cases with perineural invasion, 54% developed regional neck node metastases. Similarly in 39 cases with lymphovascular invasion, 61% developed regional neck node metastases. Association of both of these parameters with the development of regional neck node metastases was significant.
We recommend prophylactic selective neck dissection in early stage SCC of oral tongue, especially with depth of invasion more than 5 mm, perineural and lymphovascular invasion.
分析口腔舌部T1-2 N0期鳞状细胞癌（SCC）的各种人口统计学、临床和组织病理学因素，以确定区域复发的高危组，该组患者将从选择性颈清扫术中获益。
对一组因口腔舌部T1-2 N0期SCC接受经口广泛舌切除术且无可触及或超声（USG）检测到的淋巴结转移的患者进行回顾性结局分析。通过触诊、系列USG颈部检查和细针穿刺细胞学检查对患者进行随访。
176例患者中，69例（39%）在随访期间出现复发。58例发生区域颈部淋巴结转移，即总体区域淋巴结复发率为33%。53例（91%）发生区域颈部淋巴结转移的患者经进一步治疗成功挽救。在110例肿瘤厚度超过5 mm的患者中，39%发生区域颈部淋巴结转移。这种关联具有显著性（P = 0.0402）。在44例有神经周围侵犯的患者中，54%发生区域颈部淋巴结转移。同样，在39例有脉管侵犯的患者中，61%发生区域颈部淋巴结转移。这两个参数与区域颈部淋巴结转移的发生均具有显著关联。
我们建议对口腔舌部早期SCC进行预防性选择性颈清扫，尤其是对于浸润深度超过5 mm、有神经周围侵犯和脉管侵犯的患者。
