颊黏膜鳞状细胞癌的治疗及预后分析.DOCVIP

临床医学论文-颊黏膜鳞状细胞癌的治疗及预后分析 ????????????? 作者：李德志　徐震纲　唐平章　吴跃煌 【摘要】? 目的? 总结颊黏膜鳞癌的治疗方法及分析影响预后的因素。方法? 回顾我科于1987～1999年收治的52例颊黏膜鳞癌患者，分析病理分期、淋巴结情况、上下颌骨受侵与否、治疗失败等对预后的影响。结果? 52例颊黏膜鳞癌，11例单纯手术，41例术前放疗。5年生存率为56.4%，早期（Ⅰ+Ⅱ期）和晚期（Ⅲ+Ⅳ期）5年生存率分别为64.6%、53.0%。影响预后的因素有：（1）鳞癌病理分级，高分化者明显好于低分化者；（2）颈部淋巴结情况，cN0术后淋巴结阳性率为14%，cN1～3术后淋巴结阳性率为44%，病理淋巴结阳性和阴性的5年生存率分别为35.7%和64.8%；多因素分析发现影响预后的因素包括临床和病理分期的早晚。治疗失败以局部复发占多数，共出现11例局部复发，3例颈部淋巴结复发或转移，4例远处转移。结论? 颊黏膜鳞癌手术中的局部处理很重要，应注意保留足够的安全界，并需提高一期修复的能力。要重视对颈部淋巴结的处理，对cN0病例应行肩胛舌骨肌上清扫。 　　【关键词】? 颊黏膜鳞状细胞癌；预后；肿瘤；修复 　　Treatment and prognosis of buccal squamous carcinoma 　　【Abstract】? Objective? To review the treatment for buccal squamous carcinoma and analyse the prognostic factors.Methods? From January 1987 to December 1999,52 buccal squamous carcinoma patients were treated.The treatment methods were reviewed and the relations between pathological results,lymph metastases,maxillary or mandibular invasion,or primary treatment failure and prognosis were analysed.Results? Of the 52 patients,11 received surgery alone and the other 41 ones received preoperative radiation.Total 5-year survival was 56.4%,and that of early stage（stageⅠ+Ⅱ）or late stage (stage Ⅲ+Ⅳ) was 64.6% and 53.0% respectively.There was significant difference between high differentiated and poor differentiated squamous carcinoma.14% of cN0 patients got pathological positive neck lymph nodes and 44% of cN+ got pathological positive neck lymph nodes.5-year survival with pathological positive or negative neck lymph nodes were 35.7% and 64.8% respectively.Of the 52 patients,11 relapsed in local sites,3 recurred in regional lymph nodes and 4 got distant metastasis.Cox regression analysis showed that clinical and pathological stage predicted the outcome of buccal squamous carcinoma.Conclusion?To treat buccal squamous carcinoma,careful management of local site of the tumors is very important for better prognosis.Adequate security margin is needed during operation.Management of neck lymph nodes should also be active