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早期口腔鳞状细胞癌原发切除及前哨淋巴结活检后的长期言语和吞咽功能。

Long-term speech and swallowing function after primary resection and sentinel node biopsy for early oral squamous cell carcinoma.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland.

Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Switzerland.

出版信息

Oral Oncol. 2019 Feb;89:127-132. doi: 10.1016/j.oraloncology.2018.12.027. Epub 2019 Jan 9.

Abstract

OBJECTIVES

Analysis of long-term speech and swallowing function and subjective quality of life (QOL) after primary resection and sentinel node biopsy (SNB) in patients with early stage (cT1/T2) oral squamous cell carcinomas (OSCC).

MATERIAL AND METHODS

Eighty-one consecutive patients treated primarily by transoral resection without flap reconstruction and SNB for a cT1/T2 OSCC were included. Completion neck dissection (CND) was indicated in case of occult disease in the sentinel nodes. Adjuvant radiation (aRT) was administered according to the ultimate lymph node status. All patients showed no evidence of disease at time of analysis. Speech and swallowing function were assessed using standardized clinical examinations (11-item, articulation test) and validated questionnaires on subjective QOL (MDADI, FIGS). Median follow-up was 60 months (range 13-159 months) after initial treatment.

RESULTS

In all assessments for speech and swallowing, the entire study cohort achieved very high scores, with mean values located in the highest 10% of the scales. Neither tumor size nor site, age, pN-category, CND, and aRT had significant impact on functional outcomes and subjective QOL with the exception of lower scores in the global and physical scores of MDADI after CND or aRT, and articulation in the population over 60 years of age.

CONCLUSION

Transoral resection without reconstruction and SNB for early OSCC achieves excellent outcome with regard to speech, swallowing and subjective QOL.

摘要

目的

分析早期口腔鳞状细胞癌(OSCC)患者行原发肿瘤切除术和前哨淋巴结活检(SNB)后长期的言语和吞咽功能以及主观生活质量(QOL)。

材料和方法

共纳入 81 例连续的早期(cT1/T2)口腔 OSCC 患者,均接受经口切除术且未行皮瓣重建及 SNB 治疗。如果前哨淋巴结有隐匿性疾病,则进行补充性颈部清扫术(CND)。根据最终的淋巴结状态,进行辅助放疗(aRT)。所有患者在分析时均无疾病证据。采用标准化临床检查(11 项,发音测试)和验证性 QOL 问卷(MDADI、FIGS)评估言语和吞咽功能。初始治疗后中位随访时间为 60 个月(范围 13-159 个月)。

结果

在所有言语和吞咽评估中,整个研究队列均取得了非常高的分数,平均值位于量表的最高 10%。除了 CND 或 aRT 后 MDADI 的总体和生理评分以及 60 岁以上人群的发音评分较低外,肿瘤大小和部位、年龄、pN 分期、CND 和 aRT 对功能结果和主观 QOL 均无显著影响。

结论

对于早期 OSCC,经口切除术不重建和 SNB 可获得极好的言语、吞咽和主观 QOL 结果。

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