Byers R M, El-Naggar A K, Lee Y Y, Rao B, Fornage B, Terry N H, Sample D, Hankins P, Smith T L, Wolf P J
Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Head Neck. 1998 Mar;20(2):138-44. doi: 10.1002/(sici)1097-0347(199803)20:2<138::aid-hed7>3.0.co;2-3.
When to do a neck dissection as part of the surgical treatment for a patient with squamous carcinoma of the oral tongue is controversial, particularly when the primary can be resected without entering the neck. If the patient who is at high risk for having occult nodal disease in the neck can be identified, node dissection with the glossectomy could be justified. To better identify patients for this procedure, we correlated various tumor and patient factors along with preoperative diagnostic studies with the presence or absence of pathologically positive nodes in a group of patients who underwent node dissection.
Ninety-one previously untreated patients with biopsy-proved squamous carcinoma of the oral tongue were prospectively studied. All patients had a glossectomy and neck dissection as their initial treatment. The pathology findings (ie, lymph nodes with squamous cancer) were correlated with many preoperative and intraoperative factors, and a statistical analysis was made.
The use of computed tomography and ultrasound was not better than the clinical examination in determining the presence or absence of nodal metastases. The best predictors were depth of muscle invasion, double DNA aneuploidy, and histologic differentiation of the tumor.
All patients with stage T2-T4 squamous cancers of the oral tongue should have an elective dissection of the neck. Patients with T1N0 cancer who have a double DNA-aneuploid tumor, depth of muscle invasion > 4 mm, or have a poorly differentiated cancer should definitely undergo elective neck dissection. Ultrasound and computed tomography are of little value in predicting which patients have positive nodes.
对于舌鳞状细胞癌患者，何时进行颈部清扫作为手术治疗的一部分存在争议，尤其是当原发灶可以在不进入颈部的情况下切除时。如果能够识别出颈部隐匿性淋巴结转移风险较高的患者，那么在进行舌切除术时同时进行淋巴结清扫可能是合理的。为了更好地识别适合该手术的患者，我们将一组接受淋巴结清扫的患者的各种肿瘤和患者因素以及术前诊断研究与病理阳性淋巴结的有无进行了关联分析。
前瞻性研究了91例未经治疗且经活检证实为舌鳞状细胞癌的患者。所有患者均以舌切除术和颈部清扫作为初始治疗。将病理结果（即有鳞状癌的淋巴结）与许多术前和术中因素进行关联，并进行统计分析。
在确定有无淋巴结转移方面，计算机断层扫描和超声检查并不比临床检查更好。最佳预测因素是肌肉浸润深度、双倍体DNA非整倍体以及肿瘤的组织学分化。
所有T2 - T4期舌鳞状癌患者均应进行选择性颈部清扫。T1N0期癌症患者若有双倍体DNA非整倍体肿瘤、肌肉浸润深度> 4 mm或为低分化癌，则肯定应进行选择性颈部清扫。超声和计算机断层扫描在预测哪些患者有阳性淋巴结方面价值不大。
