van Es R J, van Nieuw Amerongen N, Slootweg P J, Egyedi P
Department of Oral and Maxillofacial Surgery, University Hospital Utrecht, The Netherlands.
Arch Otolaryngol Head Neck Surg. 1996 May;122(5):521-5. doi: 10.1001/archotol.1996.01890170055011.
To establish whether histopathologic variables other than the pathologist's statement of complete excision predict recurrence of squamous cell carcinoma at the primary site and therefore indicate local postoperative radiotherapy.
Retrospective analysis of clinical data and review of slides of resection specimens.
Tertiary care, hospital-based clinic.
Eighty-two patients who had complete excision only (histologically based) of a T1 or T2 squamous cell carcinoma of the mobile tongue or floor of the mouth but did not receive any form of immediate postoperative radiotherapy. Twenty-nine patients underwent local resection without treatment of the NO neck; in 53 patients a neck dissection was also performed.
Evaluation of recurrent tumor above the clavicles until 4 years postoperatively and of second and third primaries. Infiltrative depth was evaluated in 73 cases and spidery spread, perineural spread, and angioinvasion in 70 cases.
Of the squamous cell carcinoma, 27% were well differentiated and 73% were moderately differentiated; depth of invasion was 5 mm or more in 57%, a spidery growth pattern was present in 51%, there was perineural spread in 16%, and angioinvasion was found in 3%. Recurrences at the primary site, not linked to histopathologic findings, occurred in 4%; 17% of the patients had second primary tumors in the head and neck region, 15% had neck conversions, and 1% had neck recurrence.
When excision of a small squamous cell carcinoma of the mobile tongue or the floor of the mouth is histologically complete, other histopathologic variables are irrelevant in predicting recurrence at the primary site, and local radiotherapy is not indicated, considering the morbidity and high number of second and third primary tumors to be expected that will require future new treatment.
确定除病理学家关于完全切除的声明之外的组织病理学变量是否可预测原发性鳞状细胞癌的复发，从而指示局部术后放疗。
对临床数据进行回顾性分析并复查切除标本的切片。
三级医疗、以医院为基础的诊所。
82例仅接受了（基于组织学的）T1或T2期活动期舌或口底鳞状细胞癌完全切除但未接受任何形式即刻术后放疗的患者。29例患者接受了局部切除且未治疗NO颈部；53例患者还进行了颈部清扫术。
评估术后4年内锁骨上方复发性肿瘤以及第二和第三原发性肿瘤情况。对73例病例评估浸润深度，对70例病例评估蛛网状扩散、神经周围扩散和血管浸润情况。
鳞状细胞癌中，27%为高分化，73%为中分化；57%的浸润深度为5mm或更深，51%存在蛛网状生长模式，16%存在神经周围扩散，3%存在血管浸润。与组织病理学结果无关的原发性部位复发率为4%；17%的患者在头颈部区域有第二原发性肿瘤，15%有颈部转移，1%有颈部复发。
当活动期舌或口底小鳞状细胞癌的切除在组织学上为完全切除时，其他组织病理学变量在预测原发性部位复发方面无关紧要，且考虑到预期的发病率以及大量需要未来新治疗的第二和第三原发性肿瘤，不建议进行局部放疗。
