伴有神经周围侵犯的口腔舌癌的复发模式。
Patterns of recurrence in oral tongue cancer with perineural invasion.
机构信息
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
出版信息
Head Neck. 2018 Jun;40(6):1287-1295. doi: 10.1002/hed.25110. Epub 2018 Mar 9.
BACKGROUND
Although perineural invasion (PNI) is recognized as an adverse prognostic factor in oral tongue squamous cell carcinoma (SCC), the patterns of failure are poorly defined.
METHODS
Patients with oral tongue SCC who received primary surgical treatment were identified. Specimens were reviewed by head and neck pathologists. Disease-specific survival (DSS) and locoregional recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant recurrence-free survival (DRFS) were calculated. The PNI and PNI characteristics were analyzed as predictors of outcome. The utility of grading the extent of PNI was assessed by quantifying the number of PNI foci per slide reviewed, nerve caliber, and percent circumference involved.
RESULTS
Patients with PNI had a decreased DSS; however, PNI was not predictive of LRFS or RRFS. Patients with PNI were more likely to develop a distant recurrence and 19.40 (confidence interval [CI] 6.70-56.14; P < .001) times more likely to develop a distant recurrence if PNI foci density was >1.
CONCLUSION
The presence of PNI in oral tongue SCC predicts worse DSS, with distant recurrence as the most common pattern of failure. High PNI foci density is associated with worse DRFS.
背景
尽管神经周围侵犯（PNI）被认为是口腔舌鳞状细胞癌（SCC）的一个不良预后因素，但失败模式仍不清楚。
方法
确定了接受原发性手术治疗的口腔舌 SCC 患者。由头颈病理学家对标本进行了复查。计算了疾病特异性生存率（DSS）、局部区域无复发生存率（LRFS）、区域无复发生存率（RRFS）和远处无复发生存率（DRFS）。分析了 PNI 及其特征作为预后预测因子。通过量化每张切片中 PNI 焦点的数量、神经口径和受累周长的百分比，评估了 PNI 分级程度的实用性。
结果
有 PNI 的患者 DSS 降低；然而，PNI 并不能预测 LRFS 或 RRFS。有 PNI 的患者更有可能发生远处复发，并且如果 PNI 焦点密度>1，则发生远处复发的可能性高 19.40 倍（置信区间 [CI] 6.70-56.14；P<0.001）。
结论
口腔舌 SCC 中存在 PNI 预测 DSS 更差，远处复发是最常见的失败模式。高 PNI 焦点密度与较差的 DRFS 相关。
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