Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy.
Unit of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
Head Neck. 2021 Aug;43(8):2510-2522. doi: 10.1002/hed.26718. Epub 2021 Apr 24.
Oral tongue squamous cell carcinoma (OTSCC) is a quite peculiar disease from an anatomical and biological standpoint. An increasing amount of literature highlights the existence of a small subset of T1-T2N0 OTSCC, properly resected on a margin-dependent basis, which conversely proved higher than expected rates of loco-regional/distant failure and disease-specific mortality. These specific high-risk tumors might not have a margin-dependent disease and could possibly benefit from a more aggressive upfront loco-regional treatment, especially addressing the so-called T-N tract. Widespread adoption of a histopathological risk model would allow early recognition of these high-risk diseases and, consequently, intensification of the traditional treatment strategies in that specific niche. We reviewed the available knowledge trying to shed light on the potential determinants of the dismal prognosis of these high-risk OTSCC, with special reference to the role of overlooked T-N tract involvement and possible alternatives in terms of elective neck management and risk stratification.
口腔舌鳞状细胞癌（OTSCC）从解剖学和生物学的角度来看是一种相当特殊的疾病。越来越多的文献强调了一小部分 T1-T2N0 OTSCC 的存在，这些肿瘤基于边缘依赖性进行适当切除，但相反地，局部区域/远处失败和疾病特异性死亡率的发生率高于预期。这些特定的高危肿瘤可能没有边缘依赖性疾病，并且可能受益于更积极的局部区域初始治疗，特别是针对所谓的 T-N 道。广泛采用组织病理学风险模型将允许早期识别这些高危疾病，并因此在该特定领域加强传统治疗策略。我们回顾了现有知识，试图阐明这些高危 OTSCC 预后不良的潜在决定因素，特别参考了被忽视的 T-N 道受累的作用以及在选择性颈部管理和风险分层方面的可能替代方案。
