Asakage T, Yokose T, Mukai K, Tsugane S, Tsubono Y, Asai M, Ebihara S
Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.
Cancer. 1998 Apr 15;82(8):1443-8. doi: 10.1002/(sici)1097-0142(19980415)82:8<1443::aid-cncr2>3.0.co;2-a.
The incidence of cervical metastases after surgery for Stages I/II carcinoma of the tongue is 30-40%. Postoperative cervical metastases are an adverse prognostic factor for patients with this malignancy. The purpose of this study was to evaluate the clinicopathologic factors associated with late cervical metastases in patients with carcinoma of the tongue.
The clinicopathologic features of 44 patients with previously untreated Stage I/II carcinoma of the tongue were reviewed. All patients were treated with partial glossectomy only.
Cervical metastases developed in 21 of 44 patients within 5 years. Factors significantly associated with the development of cervical metastases were invasive growth, differentiation, nuclear polymorphism in the deep portion, tumor border, nest formation, infiltrative growth ratio, depth, and thickness. No statistical correlations between cervical metastases and age, gender, tumor location, clinical stage, Brinkman index, alcohol index, mitosis, connective tissue, lymphocytic infiltration, or perineural invasion were found. Multivariate analysis demonstrated that only tumor thickness > 4 mm had a predictive value for cervical metastasis (risk ratio 9.4; 95% confidence interval, 1.5-57.7).
The current study data indicate that patients with Stage I/II carcinoma of the tongue > 4 mm in thickness are at increased risk for subsequent cervical metastasis. Thus, conservative supraomohyoid neck dissection is indicated in patients with Stage I/II carcinoma of the tongue > 4 mm in thickness.
舌部I/II期癌手术后颈部转移的发生率为30% - 40%。术后颈部转移是该恶性肿瘤患者的不良预后因素。本研究的目的是评估与舌癌患者晚期颈部转移相关的临床病理因素。
回顾了44例未经治疗的舌部I/II期癌患者的临床病理特征。所有患者仅接受部分舌切除术治疗。
44例患者中有21例在5年内发生颈部转移。与颈部转移发生显著相关的因素有浸润性生长、分化程度、深部核多形性、肿瘤边界、巢状形成、浸润性生长比例、深度和厚度。未发现颈部转移与年龄、性别、肿瘤位置、临床分期、布林克曼指数、饮酒指数、有丝分裂、结缔组织、淋巴细胞浸润或神经周围浸润之间存在统计学相关性。多因素分析表明，只有肿瘤厚度>4mm对颈部转移有预测价值（风险比9.4；95%置信区间，1.5 - 57.7）。
目前的研究数据表明，厚度>4mm的舌部I/II期癌患者发生后续颈部转移的风险增加。因此，对于厚度>4mm的舌部I/II期癌患者，建议行保守性肩胛舌骨上颈清扫术。
