Schilling C, Shaw R, Schache A, McMahon J, Chegini S, Kerawala C, McGurk M
Department of Oral and Maxillofacial Surgery, St Georges Hospital, Blackshaw Road, Tooting, London, England, SW17 0QT.
Department of Molecular & Clinical Cancer Medicine, University of Liverpool & Aintree University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, Merseyside, England, L9 7AL.
Br J Oral Maxillofac Surg. 2017 Oct;55(8):757-762. doi: 10.1016/j.bjoms.2017.07.007. Epub 2017 Aug 30.
Recent data have confirmed that elective surgical management of the cN0 neck improves survival in patients with early (T1-T2) oral squamous cell carcinoma (SCC), and is better than watchful waiting. However, elective neck dissection (END) may not always be necessary. Sentinel node biopsy (SNB), which is a reliable staging test for patients with early disease and a radiologically N0 neck, can detect occult metastases with a sensitivity of 86%-94%. Patients with no sign of metastases on SNB could avoid neck dissection, and individual treatment should reduce both morbidity and cost. Currently, SNB for oral SCC is available at a limited number of centres in the UK, but this is likely to change as national guidelines have recommended that it is incorporated into the standard treatment pathway. It is therefore important to understand the current evidence that supports its use, its limitations and related controversies, and to plan for a validated training programme.
近期数据已证实，对cN0颈部进行择期手术治疗可提高早期（T1-T2）口腔鳞状细胞癌（SCC）患者的生存率，且优于观察等待。然而，选择性颈清扫术（END）并非总是必要的。前哨淋巴结活检（SNB）对早期疾病且颈部影像学检查为N0的患者是一种可靠的分期检查，其检测隐匿性转移的灵敏度为86%-94%。SNB未发现转移迹象的患者可避免颈清扫术，个体化治疗应能降低发病率和成本。目前，英国仅有少数中心可开展口腔SCC的SNB，但随着国家指南建议将其纳入标准治疗路径，这种情况可能会改变。因此，了解支持其应用的现有证据、其局限性及相关争议，并规划一个经过验证的培训项目非常重要。
