Morikawa T, Shibahara T, Takano M
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan.
Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan.
Int J Oral Maxillofac Surg. 2023 Feb;52(2):161-167. doi: 10.1016/j.ijom.2022.06.001. Epub 2022 Jun 18.
The control of enclosed oral epithelial dysplasia is important for the control of oral cancer. Fluorescence visualization and iodine solution are able to detect oral epithelial dysplasia and surrounding oral cancer. The purpose of this study was to clarify the effectiveness of combining fluorescence visualization and iodine solution-guided surgery for early tongue cancer. Participants comprised 264 patients with primary early tongue cancer who underwent surgery. The surgical margin was set at 10 mm outside the clinical tumour, and 5 mm outside the area of fluorescence visualization loss, and 5mm outside the iodine unstained area. The 5-year disease-free survival rate was 87.1% vs 76.1% (P = 0.016) and the 5-year local control rate was 98.6% vs 93.0% (P = 0.008) for combination-guided surgery when compared to conventional surgery. Positive margin rates were 0% for cancer, and 6.5% and 0% for low- and high-grade dysplasia, respectively, with combination-guided surgery (P = 0.257). Multivariate analysis revealed that combination-guided surgery (odds ratio 0.140, 95% confidence interval 0.045-0.437; P < 0.001) and intraoperative frozen section examination (odds ratio 0.302; 95% confidence interval 0.115-0.791; P = 0.015) were significantly associated with local control. The combination of fluorescence visualization and iodine solution are effective in selecting surgical margins for early tongue cancer.
控制口腔上皮发育异常对于口腔癌的防治至关重要。荧光可视化和碘溶液能够检测口腔上皮发育异常及周围的口腔癌。本研究旨在阐明荧光可视化与碘溶液引导手术相结合用于早期舌癌的有效性。研究对象包括264例接受手术治疗的原发性早期舌癌患者。手术切缘设定在临床肿瘤外10毫米处、荧光可视化消失区域外5毫米处以及碘不着色区域外5毫米处。与传统手术相比，联合引导手术的5年无病生存率为87.1%，而传统手术为76.1%（P = 0.016）；联合引导手术的5年局部控制率为98.6%，而传统手术为93.0%（P = 0.008）。联合引导手术的癌症切缘阳性率为0%，低级别和高级别发育异常的切缘阳性率分别为6.5%和0%（P = 0.257）。多因素分析显示，联合引导手术（比值比0.140，95%置信区间0.045 - 0.437；P < 0.001）和术中冰冻切片检查（比值比0.302；95%置信区间0.115 - 0.791；P = 0.015）与局部控制显著相关。荧光可视化与碘溶液相结合对于早期舌癌手术切缘的选择是有效的。
