Cariati Paolo, Cabello Serrano Almudena, Marin Fernandez Ana, Julia Martinez Miguel Angel, Fernandez Solis Jose, Martinez Lara Ildefonso
Cirugia Oral y Maxilofacial, Hospital Universitario Virgen de las Nieves, Granada, Andalucia, Spain.
Craniomaxillofac Trauma Reconstr. 2019 Mar;12(1):8-13. doi: 10.1055/s-0038-1668583. Epub 2018 Aug 27.
The main aim of the present report is to study the pattern of distribution of cervical metastasis in buccal mucosa cancer and to discuss the various therapeutic options available. Fifty-three patients with squamous cell carcinoma of the buccal mucosa treated with tumorectomy and selective neck dissection were included in the study. We also studied the relationship between specific pathological features and overall survival. Level Ib was the most affected level, followed by level IIa. T stage, N stage, N involvement tumor thickness, extracapsular spread (ECS), and vascular invasion were associated with poorer outcomes regarding overall survival ( < 0.001). Carcinoma of the buccal mucosa should be treated aggressively from the early stages. A large tumorectomy of the primary tumor is required to reduce the number of local recurrences. Moreover, we recommend performing a supraomohyoid neck dissection even in cT1N0 if there is a suspicion that the tumor thickness may be greater than 0.4 cm. The high risk of local recurrence obliges protection of the neck from a future cervical recurrence even in T1 small tumors. This could reduce the risk of cervical involvement during the follow-up and improve overall survival rates.
本报告的主要目的是研究颊黏膜癌颈转移的分布模式,并探讨可用的各种治疗选择。本研究纳入了53例接受肿瘤切除术和选择性颈清扫术治疗的颊黏膜鳞状细胞癌患者。我们还研究了特定病理特征与总生存期之间的关系。Ib级是受影响最严重的级别,其次是IIa级。T分期、N分期、N受累情况、肿瘤厚度、包膜外扩散(ECS)和血管侵犯与总生存期较差的结果相关(P < 0.001)。颊黏膜癌应从早期就积极治疗。需要对原发肿瘤进行大范围切除以减少局部复发的数量。此外,如果怀疑肿瘤厚度可能大于0.4 cm,即使是cT1N0患者,我们也建议进行肩胛舌骨肌上颈清扫术。即使是T1期小肿瘤,局部复发的高风险也要求对颈部进行保护以防未来发生颈复发。这可以降低随访期间颈部受累的风险并提高总生存率。