cN0早期舌体鳞癌的颈部处理探讨

摘要

目的 通过对临床早期舌体鳞癌患者的回顾研究,探讨预防性颈淋巴结清扫和严密观察2种治疗方式的合理应用.方法 收集132例cN0早期舌体鳞癌病例,根据颈部处理方案分为颈清组(71例)和观察组(61例),统计分析临床、病理和随访资料.结果 颈清组和观察组的3年生存率分别为87.3％、83.4％.颈清组T1、T2病例的3年生存率分别为89.3％、83.3％,观察组T1、T2病例的3年生存率分别为89.6％和58.3％.T2以3.0 cm为界,观察组T2b生存曲线较T2a下降趋势明显.低分化病例的生存曲线较高分化和中分化显著下降.结论 T1期的cN0舌体鳞癌颈部可严密观察;小于3.0 cm的T2病例仍可采用严密观察,如果病理分化差可考虑预防性颈淋巴结清扫;大于3.0 cm的T2病例应采用预防性颈淋巴结清扫.%Objective This retrospective study is to analyze the outcomes of cN0 stage tongue squamous cell carcinoma and to discuss a reasonable neck management for these cases. Methods Totally 132 cases of cN0 stage tongue squamous cell carcinomas were included. Seventy-one cases were performed neck dissection (group ND), 61 cases were under wait-and-see (group WS). The clinical, pathological and follow up data of two groups were analyzed. Results The cumulative three-year-survival between group ND and group WS were 87.3% and 83.4% respectively. In group ND, the survival of T1 and T2 cases were 89.3% and 83.3% respectively, while 89.6% and 58.3% in WS. For T2b cases which the size was larger than 3.0 cm, the survival of group WS was greatly lower than that of group ND. Both in ND and WS groups. The pathologically poor differentiation cases got poor survival than middle and well cases. Conclusion The wait-and-see policy is recommanded for T1 stage cN0 tongue squamous cell carcinoma. For T2 cases that the tumor size is smaller than 3.0 cm, the wait-and-see is also reasonable, while the neck dissection should be considered in cases of poor differentiation. For large T2 cases, the selective neck dissection should be performed.