口腔癌辅助放疗的必要性：侵袭深度而非肿瘤直径。
Need for adjuvant radiotherapy in oral cancer: depth of invasion rather than tumor diameter.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
出版信息
Eur Arch Otorhinolaryngol. 2023 Jan;280(1):339-346. doi: 10.1007/s00405-022-07561-x. Epub 2022 Aug 1.
PURPOSE
The 8th edition of the TNM Cancer Staging Manual incorporates depth of invasion (DOI) into the pathologic tumor classification for oral squamous cell carcinoma (OSSC). While deep invading tumors with small tumor diameters (TD) have been categorized as early stage tumors in the 7th edition, they are now upstaged, potentially influencing the decision to initiate adjuvant radiotherapy (RT).
METHODS
OSCC patients surgically treated with curative intent between 2010 and 2019 were consecutively included. Tumors were staged based on TD only (according to the 7th edition TNM Cancer Staging Manual), then restaged based solely on DOI.
RESULTS
Of the 133 included patients, 58 patients (43.6%) had a different pT-stage when using DOI instead of TD for staging (upstaging in 23.3%). Overall survival (OS) was significantly worse in patients who were upstaged with DOI. In addition, stratification by adjuvant RT showed significant worse OS in upstaged patients without receiving adjuvant RT.
CONCLUSIONS
DOI seems to be an import indicator for adjuvant RT in OSCC-patients.
目的
第 8 版 TNM 癌症分期手册将浸润深度（DOI）纳入口腔鳞状细胞癌（OSSC）的病理肿瘤分类。虽然第 7 版中，直径较小的深部浸润肿瘤被归类为早期肿瘤，但现在它们被升级，这可能会影响是否开始辅助放疗（RT）的决策。
方法
连续纳入 2010 年至 2019 年间接受根治性手术治疗的 OSCC 患者。肿瘤根据 TD 进行分期（根据第 7 版 TNM 癌症分期手册），然后仅根据 DOI 重新分期。
结果
在纳入的 133 名患者中，58 名患者（43.6%）在使用 DOI 分期时，pT 分期不同（23.3%的病例升级）。DOI 升级的患者总生存（OS）显著更差。此外，根据辅助 RT 分层，未接受辅助 RT 的升级患者的 OS 显著更差。
结论
DOI 似乎是 OSCC 患者接受辅助 RT 的一个重要指标。
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