Miura Kei-Ichiro, Otsuru Mitsunobu, Fukushima Hiromasa, Omori Keisuke, Naruse Tomofumi, Umeda Masahiro, Yamada Tomohiro
Department of Oral and Maxillofacial Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN.
Department of Oral and Maxillofacial Surgery, Kanagawa Dental University, Yokosuka, JPN.
Cureus. 2025 Feb 2;17(2):e78395. doi: 10.7759/cureus.78395. eCollection 2025 Feb.
Surgery is the standard treatment for oral squamous cell carcinoma (OSCC), and concurrent chemoradiotherapy (CRT) is recommended in cases where extranodal extension (ENE) or positive margins are found histopathologically after surgery. However, the indications and efficacy of CRT remain controversial. In this study, we investigated the efficacy of postoperative treatment by examining risk factors for postoperative OSCC recurrence.
We investigated the postoperative treatment and prognosis of 52 patients with OSCC with high-risk factors for recurrence (28 with ENE only, 17 with positive margins only, and seven with both). ENE was classified into minor ENE (ENEmi < 2 mm) and major ENE (ENEma ≥ 2 mm).
The prognosis for ENEmi was good regardless of whether postoperative treatment was administered; however, the prognosis for ENEma was significantly poor. In the ENEma group, the prognosis of the patients who underwent radiotherapy (RT) or CRT was better than that of patients who did not undergo postoperative treatment, with no significant differences between the RT and CRT groups. In patients with positive margins, the prognosis was better in those who underwent additional resection than in those who underwent CRT.
Patients with ENEma have a poor prognosis and require additional treatment with RT or CRT. Re-resection may improve the prognosis in patients with positive margins.
手术是口腔鳞状细胞癌（OSCC）的标准治疗方法，对于术后病理检查发现有淋巴结外侵犯（ENE）或切缘阳性的病例，推荐同步放化疗（CRT）。然而，CRT的适应证和疗效仍存在争议。在本研究中，我们通过检查术后OSCC复发的危险因素来探讨术后治疗的疗效。
我们调查了52例具有高复发风险因素的OSCC患者的术后治疗及预后情况（28例仅伴有ENE，17例仅切缘阳性，7例两者皆有）。ENE分为微小ENE（ENEmi < 2 mm）和大ENE（ENEma≥2 mm）。
无论是否进行术后治疗，微小ENE患者的预后都较好；然而，大ENE患者的预后明显较差。在大ENE组中，接受放疗（RT）或CRT的患者的预后优于未接受术后治疗的患者，RT组和CRT组之间无显著差异。在切缘阳性的患者中，接受再次切除的患者的预后优于接受CRT的患者。
大ENE患者预后较差，需要接受RT或CRT的额外治疗。再次切除可能改善切缘阳性患者的预后。
