口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (11): 776-781.DOI: 10.12016/j.issn.2096-1456.2021.11.009
收稿日期:
2020-07-19
修回日期:
2020-09-27
出版日期:
2021-11-20
发布日期:
2021-07-20
通讯作者:
彭歆
作者简介:
陈震,硕士研究生,Email:
CHEN Zhen(),ZHANG Wenbo,PENG Xin(
)
Received:
2020-07-19
Revised:
2020-09-27
Online:
2021-11-20
Published:
2021-07-20
Contact:
Xin PENG
摘要:
口腔鳞状细胞癌(oral squamous cell carcinoma, OSCC)是口腔颌面部最常见的恶性肿瘤,颈部淋巴结转移是OSCC重要的生物学行为,也是影响患者预后的主要因素。颈淋巴清扫术作为颈部处理最常用的手术方式,术式的合理选择非常重要。目前的观点认为:对于临床评估有颈部淋巴结转移(clinically node-positive neck, cN+)的患者,术式可采用根治性或改良根治性颈淋巴清扫术;而对于临床评估颈部无明显转移(cN0)的患者,术式可采用择区性颈淋巴清扫术。近年来,择区性颈淋巴清扫术被越来越多的推广应用,其适应证也由cN0向cN+逐渐扩大。然而,对于OSCC cN+患者是否也可以采用择区性颈淋巴清扫术,目前仍未达成共识。本文将近年来关于OSCC cN+颈部处理的临床研究进行文献综述,分析不同的颈淋巴清扫术对cN+ OSCC预后的影响,总结OSCC cN+颈部的治疗原则。
中图分类号:
陈震,章文博,彭歆. 口腔鳞状细胞癌cN+颈部处理的研究进展[J]. 口腔疾病防治, 2021, 29(11): 776-781.
CHEN Zhen,ZHANG Wenbo,PENG Xin. Research progress on the neck management of oral squamous cell carcinoma with clinically node-positive neck[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(11): 776-781.
Authors(Year) | Country | Median follow-up time | Clinical N stage | Type of neck dissection | n | Overall neck recurrence | Disease-specific survival rate | |
---|---|---|---|---|---|---|---|---|
Schiff, et al[ | USA | 5.7 years | cN1,cN2b-cN2c | SND(I-III/IV) | 45 | 5(11.1%) | - | |
RND/MRND | 19 | 1(5.3%) | - | |||||
Patel, et al[ | Australia | 54 months | cN1-3 | SND(I-III/IV) | 24 | 2(8.3%) | - | |
RND/MRND | 43 | 12(27.9%) | - | |||||
Yanai, et al[ | Japan | 72 months | cN1 | SND(I) | 32 | 6 (18.8%) | 81.3%(3 years) | |
RND/MRND | 36 | 6 (16.7%) | 80%(3 years) | |||||
Shin, et al[ | Korea | 47 months | cN1-cN2a | SND(I-III) | 20 | 3(15.0%) | 69.2%(2 years) | |
RND/MRND | 34 | 4(11.8%) | 71.8%(2 years) | |||||
Battoo, et al[ | India | 36 months | cN1-cN2 | SND(I-III/IV) | 37 | 4(10.8%) | 60%(3 years) | |
RND/MRND | - | - | - | |||||
Feng, et al[ | 68 months | cN1-cN2b | SND(I-III/IV) | 89 | 14(15.7%) | T1-2(3 years) | T3-4 (3 years) | |
China | 67.6%(Ⅰ-Ⅲ)55.6%(Ⅰ-Ⅳ) | 54.8%(Ⅰ-Ⅲ)58.3%(Ⅰ-Ⅳ) | ||||||
RND/MRND | 101 | 13(12.9%) | 61% | 51.7% | ||||
Shimura, et al[ | Japan | 42 months | cN1-cN2 | SND(I-III) | 20 | - | 71% (cN1)(5 years) 54% (cN2)(5 years) | |
RND/MRND | 21 | - | - |
表1 cN+口腔鳞状细胞癌患者应用SND或RND/MRND的预后比较
Table 1 Comparison of the prognosis of cN+ patients with oral squamous cell carcinoma treated with SND or RND/MRND
Authors(Year) | Country | Median follow-up time | Clinical N stage | Type of neck dissection | n | Overall neck recurrence | Disease-specific survival rate | |
---|---|---|---|---|---|---|---|---|
Schiff, et al[ | USA | 5.7 years | cN1,cN2b-cN2c | SND(I-III/IV) | 45 | 5(11.1%) | - | |
RND/MRND | 19 | 1(5.3%) | - | |||||
Patel, et al[ | Australia | 54 months | cN1-3 | SND(I-III/IV) | 24 | 2(8.3%) | - | |
RND/MRND | 43 | 12(27.9%) | - | |||||
Yanai, et al[ | Japan | 72 months | cN1 | SND(I) | 32 | 6 (18.8%) | 81.3%(3 years) | |
RND/MRND | 36 | 6 (16.7%) | 80%(3 years) | |||||
Shin, et al[ | Korea | 47 months | cN1-cN2a | SND(I-III) | 20 | 3(15.0%) | 69.2%(2 years) | |
RND/MRND | 34 | 4(11.8%) | 71.8%(2 years) | |||||
Battoo, et al[ | India | 36 months | cN1-cN2 | SND(I-III/IV) | 37 | 4(10.8%) | 60%(3 years) | |
RND/MRND | - | - | - | |||||
Feng, et al[ | 68 months | cN1-cN2b | SND(I-III/IV) | 89 | 14(15.7%) | T1-2(3 years) | T3-4 (3 years) | |
China | 67.6%(Ⅰ-Ⅲ)55.6%(Ⅰ-Ⅳ) | 54.8%(Ⅰ-Ⅲ)58.3%(Ⅰ-Ⅳ) | ||||||
RND/MRND | 101 | 13(12.9%) | 61% | 51.7% | ||||
Shimura, et al[ | Japan | 42 months | cN1-cN2 | SND(I-III) | 20 | - | 71% (cN1)(5 years) 54% (cN2)(5 years) | |
RND/MRND | 21 | - | - |
图1 cN+口腔鳞状细胞癌颈淋巴清扫术式选择
Figure 1 Strategy of selective neck dissection for cN+ oral squamous cell carcinoma cN+: clinically node-positive neck; ENE: extranodal extension; SND: selective neck dissection; RND: radical neck dissection; MRND: modified radical neck dissection
[1] | 中华医学会耳鼻咽喉头颈外科学分会头颈外科学组. 头颈部鳞状细胞癌颈淋巴结转移处理的专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(1):25-33. doi: 10.3760/cma.j.issn.1673-0860.2016.01.005. |
Subspecialty Group of Head and Neck Surgery, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery. Expert consensus on management of cervical lymph node metastasis of head and neck squamous cell carcinoma[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2016, 51(1):25-33. doi: 10.3760/cma.j.issn.1673-0860.2016.01.005. | |
[2] | 中华口腔医学会口腔颌面外科专业委员会肿瘤学组. 口腔颌面部恶性肿瘤颈淋巴结转移的外科诊治指南[J]. 中国口腔颌面外科杂志, 2005, 3(1):3-9. doi: 10.3969/j.issn.1672-3244.2005.01.003. |
Chinese Society of Oral and Maxillofacial Surgery. Guideline for evaluation and surgical treatmentof cervical lymph node metastasis from oral and maxillofacial malignances[J]. Chin J Oral Maxillofac Surg, 2005, 3(1):3-9. doi: 10.3969/j.issn.1672-3244.2005.01.003. | |
[3] |
Battoo AJ, Hedne N, Ahmad SZ, et al. Selective neck dissection is effective in N1/N2 nodal stage oral cavity squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2013, 71(3):636-643. doi: 10.1016/j.joms.2012.06.181.
DOI URL |
[4] |
Shimura S, Ogi K, Miyazaki A, et al. Selective neck dissection and survival in pathologically node-positive oral squamous cell carcinoma[J]. Cancers, 2019, 11(2):269. doi: 10.3390/cancers11020269.
DOI URL |
[5] |
Doescher J, Veit JA, Hoffmann TK. The 8th edition of the AJCC Cancer Staging Manual[J]. HNO, 2017, 65(12):956-961. doi: https://doi.org/10.1007/s00106-017-0391-3.
DOI URL PMID |
[6] | 尚伟, 郑家伟. 口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读[J]. 中国口腔颌面外科杂志, 2018, 16(6):533-546. doi: 10.19438/j.cjoms.2018.06.010. |
Shang W, Zheng JW. Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx[J]. Chin J Oral Maxillofac Surg, 2018, 16(6):533-546. doi: 10.19438/j.cjoms.2018.06.010. | |
[7] | 尚伟, 郑家伟. 2019年NCCN口腔口咽癌诊疗指南更新解读[J]. 中国口腔颌面外科杂志, 2019, 17(6):481-485. doi: 10.19438/j.cjoms.2019.06.001. |
Shang W, Zheng JW. Interpretation of updated NCCN guidelines for diagnosis and treatment of oral and oropharyngeal cancer issued in 2019[J]. Chin J Oral Maxillofac Surg, 2019, 17(6):481-485. doi: 10.19438/j.cjoms.2019.06.001. | |
[8] |
Crile G. Landmark article Dec 1, 1906: excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. By George Crile[J]. JAMA, 1987, 258(22):3286-3293. doi: 10.1001/jama.258.22.3286.
DOI URL |
[9] |
Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity[J]. Cancer, 1990, 66(1):109-113. doi: 10.1002/1097-0142(19900701)66:13.0.CO;2-A.
URL PMID |
[10] | Pantvaidya GH, Pal P, Vaidya AD, et al. Prospective study of 583 neck dissections in oral cancers: implications for clinical practice[J]. Head Neck, 2014, 36(10):1503-1507. doi: 10.1002 /hed.23494. |
[11] | Patel S, Singh I, Gulati A, et al. A Study on neck nodes in oral cancers, with special reference to skip metastasis[J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(S1):474-481. doi: 10.1007/s12070-018-1360-1. |
[12] |
Woolgar JA. The topography of cervical lymph node metastases revisited: the histological findings in 526 sides of neck dissection from 439 previously untreated patients[J]. Int J Oral Maxillofac Surg, 2007, 36(3):219-225. doi: 10.1016/j.ijom.2006.10.014.
DOI URL |
[13] |
Davidson BJ, Kulkarny V, Delacure MD, et al. Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract[J]. Am J Surg, 1993, 166(4):395-398. doi: 10.1016/S0002-9610(05)80340-X.
URL PMID |
[14] |
Chepeha DB, Taylor RJ, Chepeha JC, et al. Functional assessment using Constant’s Shoulder Scale after modified radical and selective neck dissection[J]. Head Neck, 2002, 24(5):432-436. doi: 10.1002/hed.10067.
DOI URL |
[15] |
Gane EM, Michaleff ZA, Cottrell MA, et al. Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review[J]. Eur J Surg Oncol, 2017, 43(7):1199-1218. doi: 10.1016/j.ejso.2016.10.026.
DOI URL PMID |
[16] | 李少明, 高岭, 任文豪, 等. 功能性和肩胛舌骨肌上颈淋巴结清扫术治疗cN0/N1期口腔鳞癌的效果比较[J]. 中华医学杂志, 2019, 99(32):2516-2520. doi: 10.3760/cma.j.issn.0376-2491.2019.32.009. |
Li SM, Gao L, Ren WH, et al. Functional and supraomohyoid neck dissection in stage cNO/N1 oral squamous cell carcinoma[J]. Zhonghua Yi Xue Za Zhi, 2019, 99(32):2516-2520. doi: 10.3760/cma.j.issn.0376-2491.2019.32.009. | |
[17] |
Feng Z, Gao Y, Niu LX, et al. Selective versus comprehensive neck dissection in the treatment of patients with a pathologically node-positive neck with or without microscopic extracapsular spread in oral squamous cell carcinoma[J]. Int J Oral Maxillofac Surg, 2014, 43(10):1182-1188. doi: 10.1016/j.ijom.2014.05.018.
DOI URL |
[18] |
Schiff BA, Robert DB, El-Nagger A, et al. Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(10):874-878. doi: 10.1001/archotol.131.10.874.
DOI URL |
[19] |
Patel RS, Clark JR, Gao K, et al. Effectiveness of selective neck dissection in the treatment of the clinically positive neck[J]. Head Neck, 2008, 30(9):1231-1236. doi: 10.1002/hed.20870.
DOI URL |
[20] | Yanai Y, Suglura T, Imajyo I, et al. Retrospective study of selective submandibular neck dissection versus radical neck dissection for N0 or N1 necks in level I patients with oral squamous cell carcinoma[J]. J Oncol, 2012, 2012:1-8. doi: 10.1155/2012/634183. |
[21] |
Shin YS, Koh YW, Kim SH, et al. Selective neck dissection for clinically node-positive oral cavity squamous cell carcinoma[J]. Yonsei Med J, 2013, 54(1):139. doi: 10.3349/ymj.2013.54.1.139.
DOI URL |
[22] |
Feng Z, Li JN, Niu LX, et al. Supraomohyoid neck dissection in the management of oral squamous cell carcinoma: special consideration for skip metastases at level IV or V[J]. J Oral Maxillofac Surg, 2014, 72(6):1203-1211. doi: 10.1016/j.joms.2013.12.008.
DOI URL |
[23] |
Ferlito A, Rinaldo A, Silver CE, et al. Elective and therapeutic selective neck dissection[J]. Oral Oncol, 2006, 42(1):14-25. doi: 10.1016/j.oraloncology.2005.03.009.
URL PMID |
[24] |
Liaw GA, Yen CY, Chiang WF, et al. Outcome of treatment with total main tumor resection and supraomohyoid neck dissection in oral squamous cell carcinoma[J]. J Formos Med Assoc, 2006, 105(12):971-977. doi: 10.1016/S0929-6646(09)60281-3.
DOI URL |
[25] |
Liang L, Zhang T, Kong Q, et al. A meta-analysis on selective versus comprehensive neck dissection in oral squamous cell carcinoma patients with clinically node-positive neck[J]. Oral Oncol, 2015, 51(12):1076-1081. doi: 10.1016/j.oraloncology.2015.10.005.
DOI URL |
[26] |
Kolli VR, Datta RV, Orner JB, et al. The Role of supraomohyoid neck dissection in patients with positive nodes[J]. Arch Otolaryngol Head Neck Surg, 2000, 126(3):413-416. doi: 10.1001/archotol.126.3.413.
DOI URL |
[27] |
Schmitz S, Machiels JP, Weynand B, et al. Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma[J]. Eur Arch Otorhinolaryngol, 2009, 266(3):437-443. doi: 10.1007/s00405-008-0767-9.
DOI URL PMID |
[28] |
Rodrigo JP, Grilli G, Shah JP, et al. Selective neck dissection in surgically treated head and neck squamous cell carcinoma patients with a clinically positive neck: systematic review[J]. Eur J Surg Oncol, 2018, 44(4):395-403. doi: 10.1016/j.ejso.2018.01.003.
DOI URL PMID |
[29] |
López F, Fernández-Vañes L, García-Cabo P, et al. Selective neck dissection in the treatment of head and neck squamous cell carcinoma patients with a clinically positive neck[J]. Oral Oncol, 2020, 102:104565. doi: 10.1016/j.oraloncology.2020.104565.
DOI URL |
[30] |
Givi B, Linkov G, Ganly I, et al. Selective neck dissection in node-positive squamous cell carcinoma of the head and neck[J]. Otolaryngol Head Neck Surg, 2012, 147(4):707-715. doi: 10.1177/0194599812444852.
DOI URL |
[31] |
Byers RM, Weber RS, Andrews T, et al. Frequency and therapeutic implications of "skip metastasis" in the neck from squamous carcinoma of the tongue[J]. Head Neck, 1997, 19(1):14-19. doi: 10.1002/(SICI)1097-0347(199701)19: 13.0.CO;2-Y.
DOI URL |
[32] |
Dias FL, Lima RA, Kligerman J, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth[J]. Otolaryngol Head Neck Surg, 2006, 134(3):460-465. doi: 10.1016/j.otohns.2005.09.025.
DOI URL |
[33] |
Ferlito A, Silver CE, Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies[J]. Br J Oral Maxillofac Surg, 2009, 47(1):5-9. doi: 10.1016/j.bjoms.2008.06.001.
DOI URL PMID |
[34] | 毛驰, 俞光岩. 口腔鳞癌N0和N1颈部淋巴结的处理[J]. 现代口腔医学杂志, 2005(3):316-319. doi: 10.3969/j.issn.1003-7632.2005.03.031. |
Mao C, Yu GY. Management of N0 and N1 neck of oral squamous cell carcinoma[J]. J Modern Stomatol, 2005(3):316-319. doi: 10.3969/j.issn.1003-7632.2005.03.031. | |
[35] |
Dogan E, Cetinayak HO, Sarioglu S, et al. Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection[J]. J Laryngol Otol, 2014, 128(3):268-273. doi: 10.1017/S002221511 4000267.
DOI URL PMID |
[1] | 吴补领,罗奕菲,徐稳安,童忠春. 恒牙牙髓炎的活髓保存治疗[J]. 口腔疾病防治, 2021, 29(7): 433-441. |
[2] | 王倩倩,丁丹丹,丁翔,韩瑞,韩影影,周美云,徐锦程. Bex1和NF-kBp65在舌鳞状细胞癌组织中的表达及意义[J]. 口腔疾病防治, 2021, 29(6): 383-387. |
[3] | 李明,南欣荣,原振英,唐瞻贵. 磁共振成像评估舌鳞状细胞癌浸润深度的准确性分析[J]. 口腔疾病防治, 2021, 29(5): 322-327. |
[4] | 王安训. 口腔黏膜相关疾病免疫功能检测及意义[J]. 口腔疾病防治, 2021, 29(2): 73-80. |
[5] | 杨慧,王翔,张磊,王文梅,段宁,李若玮,张苗苗. 19例口腔黏膜恶性黑色素瘤临床分析[J]. 口腔疾病防治, 2021, 29(12): 843-847. |
[6] | 黄湘雅,蔡艳玲,韦曦. 显微根尖手术的全周期管理[J]. 口腔疾病防治, 2021, 29(10): 649-655. |
[7] | 王广超,刘丽骏,蒋伟文. DNA甲基化激活磷酸肌醇代谢在口腔白斑癌变中的意义[J]. 口腔疾病防治, 2021, 29(10): 677-683. |
[8] | 王力业,高莺,田淳. 口腔鳞状细胞癌患者预后相关基因标志物的生物信息学分析[J]. 口腔疾病防治, 2021, 29(1): 27-33. |
[9] | 张骞予,杨培新,陈柏深,王林,黄志权. 舌腺样囊性癌与肺腺癌双原发恶性肿瘤病例报告及文献复习[J]. 口腔疾病防治, 2020, 28(9): 586-589. |
[10] | 王月阳,张黎丽,周伟伟,王楠. 弹性纤维夹板治疗恒牙水平根折的回顾研究[J]. 口腔疾病防治, 2020, 28(3): 163-168. |
[11] | 袁开放,陈伟良,周斌,张大明. 面颏下动脉岛状皮瓣在口腔与口咽鳞状细胞癌切除术后重建的临床效果比较[J]. 口腔疾病防治, 2020, 28(2): 84-87. |
[12] | 李瑞春,景凯岸,王丽娜,马瑞,景捷,马坚. 下颌下腺导管畸形伴多发结石病例报道及文献复习[J]. 口腔疾病防治, 2020, 28(2): 93-96. |
[13] | 王安训. 表观遗传与口腔鳞状细胞癌[J]. 口腔疾病防治, 2020, 28(10): 613-622. |
[14] | 季彤. 头颈部骨肉瘤的诊断与治疗[J]. 口腔疾病防治, 2019, 27(9): 545-550. |
[15] | 林琳,段宁,王翔,蒋红柳,王文梅. 青少年口腔疣状黄瘤病例报道及文献复习[J]. 口腔疾病防治, 2019, 27(5): 318-320. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||
本作品遵循Creative Commons Attribution 3.0 License授权许可.