Miao He-Jing, Sun Shao-Kang, Tian Yuan-Yuan, Yang Yun-Qi, Wang Shi-Hua, Bai Shuang, Chen Wei, Mao Chi, Liang Su-Xia, Yan Ying-Bin
Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin 300041, PR China; Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin 300041, PR China.
Stomatology Center, The First People's Hospital of Shunde, No.1 Azi Road, Shunde District, Foshan 528000, PR China.
Oral Oncol. 2023 May;140:106395. doi: 10.1016/j.oraloncology.2023.106395. Epub 2023 Apr 15.
To evaluate whether the pedicle submental island flap (SIF) can be safely used in the oral tongue squamous cell carcinoma (OTSCC) patients with pathologically node-positive (pN+) neck, especially pN+ at level I.
Retrospectively, 101 OTSCC patients with SIF reconstruction were enrolled. Oncological outcomes included the total locoregional recurrence, the SIF related locoregional recurrence (SRLR) which referred to the local recurrence at flap and ipsilateral neck recurrence at level I, recurrence free survival (RFS), overall survival (OS), and disease specific survival (DSS).
Sixty-one patients were pathologically node-negative (pN0) and 40 were pN+. Thirteen patients experienced locoregional recurrence, of which 5 had a SRLR. The pN+ group had a significantly higher locoregional recurrence rate, lower 5-year RFS, OS and DSS than pN0 group (P < 0.05). Patients with pN0 had a significantly higher neck RFS when compared to those with pN+ either at level I (P = 0.005) or at other levels (P < 0.001). However, the neck RFS was similar between the two subgroups of pN+ (P = 0.550). Especially, patients with pN+ at level I had a significantly higher SRLR rate (P = 0.006) compared to those with pN0 at level I. Multivariate analysis showed that pN+ was an unfavorable factor for tumor recurrence and OS.
Our data did not support the use of SIF in OTSCC patients with pN+ neck at level I due to an significantly increased SRLR rate compared to those with pN0 neck at level I.
评估带蒂颏下岛状皮瓣（SIF）是否可安全用于病理检查显示颈部淋巴结阳性（pN+）的口腔舌鳞状细胞癌（OTSCC）患者，尤其是I区pN+的患者。
回顾性纳入101例行SIF重建的OTSCC患者。肿瘤学结局包括局部区域总复发、SIF相关局部区域复发（SRLR，指皮瓣局部复发和I区同侧颈部复发）、无复发生存期（RFS）、总生存期（OS）和疾病特异性生存期（DSS）。
61例患者病理检查显示淋巴结阴性（pN0），40例为pN+。13例患者出现局部区域复发，其中5例发生SRLR。pN+组的局部区域复发率显著高于pN0组，5年RFS、OS和DSS均低于pN0组（P<0.05）。与I区pN+患者（P=0.005）或其他区域pN+患者（P<0.001）相比，pN0患者的颈部RFS显著更高。然而，pN+的两个亚组之间的颈部RFS相似（P=0.550）。特别是，与I区pN0患者相比，I区pN+患者的SRLR率显著更高（P=0.006）。多因素分析显示，pN+是肿瘤复发和OS的不利因素。
我们的数据不支持在I区pN+颈部的OTSCC患者中使用SIF，因为与I区pN0颈部患者相比，其SRLR率显著增加。
