口腔鳞状细胞癌cN+颈部处理的研究进展

doi:10.12016/j.issn.2096-1456.2021.11.009

摘要/Abstract

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。

关键词: 择区性颈淋巴清扫术, 口腔鳞状细胞癌, 颈淋巴结转移, 术后并发症, 生存质量, 预后, 辅助治疗, 治疗原则

Abstract:

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial regions. Cervical lymph node metastasis is not only an important biological behavior of oral cancer but also an important factor affecting the prognosis of oral cancer patients. As neck dissection is the most commonly used method of neck management, the appropriate choice of surgical procedure is very important. The current view is that radical neck dissection or modified radical neck dissection can be used for patients with clinically node-positive neck (cN+), while selective neck dissection can be used for patients with clinically node-negative neck (cN0). In recent years, selective neck dissection has been increasingly popularized and applied. Its implications are also gradually expanding from cN0 to cN+. However, there is still no consensus on whether selective neck dissection can also be used in patients with cN+ necks. This article reviews the clinical studies on the neck management of cN+ OSCC patients in recent years, analyzes the effects of different neck dissections on the prognosis of cN+ OSCC patients, and summarizes the treatment principles of neck management.

Key words: selective neck dissection, oral squamous cell carcinoma, cervical lymph node metastasis, postoperative complication, quality of life, prognosis, adjuvant therapy, treatment principles

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.

图/表 2

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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^[18]（2005）	USA	5.7 years	cN1,cN2b-cN2c	SND（I-III/IV）	45	5（11.1%）	-
Schiff, et al^[18]（2005）	USA	5.7 years	cN1,cN2b-cN2c	RND/MRND	19	1（5.3%）	-
Patel, et al^[19]（2008）	Australia	54 months	cN1-3	SND（I-III/IV）	24	2（8.3%）	-
Patel, et al^[19]（2008）	Australia	54 months	cN1-3	RND/MRND	43	12（27.9%）	-
Yanai, et al^[20]（2012）	Japan	72 months	cN1	SND（I）	32	6 （18.8%）	81.3%（3 years）
Yanai, et al^[20]（2012）	Japan	72 months	cN1	RND/MRND	36	6 （16.7%）	80%（3 years）
Shin, et al^[21]（2013）	Korea	47 months	cN1-cN2a	SND（I-III）	20	3（15.0%）	69.2%（2 years）
Shin, et al^[21]（2013）	Korea	47 months	cN1-cN2a	RND/MRND	34	4（11.8%）	71.8%（2 years）
Battoo, et al^[3]（2013）	India	36 months	cN1-cN2	SND（I-III/IV）	37	4（10.8%）	60%（3 years）
Battoo, et al^[3]（2013）	India	36 months	cN1-cN2	RND/MRND	-	-	-
Feng, et al^[22]（2014）		68 months	cN1-cN2b	SND（I-III/IV）	89	14（15.7%）	T1-2（3 years）	T3-4 （3 years）
	China			SND（I-III/IV）	89	14（15.7%）	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^[4]（2019）	Japan	42 months	cN1-cN2	SND（I-III）	20	-	71% （cN1）（5 years） 54% （cN2）（5 years）
Shimura, et al^[4]（2019）	Japan	42 months	cN1-cN2	RND/MRND	21	-	-

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^[18]（2005）	USA	5.7 years	cN1,cN2b-cN2c	SND（I-III/IV）	45	5（11.1%）	-
Schiff, et al^[18]（2005）	USA	5.7 years	cN1,cN2b-cN2c	RND/MRND	19	1（5.3%）	-
Patel, et al^[19]（2008）	Australia	54 months	cN1-3	SND（I-III/IV）	24	2（8.3%）	-
Patel, et al^[19]（2008）	Australia	54 months	cN1-3	RND/MRND	43	12（27.9%）	-
Yanai, et al^[20]（2012）	Japan	72 months	cN1	SND（I）	32	6 （18.8%）	81.3%（3 years）
Yanai, et al^[20]（2012）	Japan	72 months	cN1	RND/MRND	36	6 （16.7%）	80%（3 years）
Shin, et al^[21]（2013）	Korea	47 months	cN1-cN2a	SND（I-III）	20	3（15.0%）	69.2%（2 years）
Shin, et al^[21]（2013）	Korea	47 months	cN1-cN2a	RND/MRND	34	4（11.8%）	71.8%（2 years）
Battoo, et al^[3]（2013）	India	36 months	cN1-cN2	SND（I-III/IV）	37	4（10.8%）	60%（3 years）
Battoo, et al^[3]（2013）	India	36 months	cN1-cN2	RND/MRND	-	-	-
Feng, et al^[22]（2014）		68 months	cN1-cN2b	SND（I-III/IV）	89	14（15.7%）	T1-2（3 years）	T3-4 （3 years）
	China			SND（I-III/IV）	89	14（15.7%）	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^[4]（2019）	Japan	42 months	cN1-cN2	SND（I-III）	20	-	71% （cN1）（5 years） 54% （cN2）（5 years）
Shimura, et al^[4]（2019）	Japan	42 months	cN1-cN2	RND/MRND	21	-	-