- 作者：Chun-Ta Liao ; M.D.&lowast ; ; &dagger ; ; Chien-Yu Lin ; M.D.&dagger ; ; &Dagger ; ; Kang-Hsing Fan ; M.D.&lowast ; ; &Dagger ; ; Hung-Ming Wang ; M.D.&lowast ; ; § ; ; Shu-Hang Ng ; M.D.&lowast ; ; ?/sup> ; Li-Yu Lee ; M.D.&dagger ; ; ¶ ; ; Chuen Hsueh ; M.D.&dagger ; ; ¶ ; ; I-How Chen ; M.D.&lowast ; ; &dagger ; ; Shiang-Fu Huang ; M.D.&lowast ; ; &dagger ; ; Chung-Jan Kang ; M.D.&lowast ; ; &dagger ; ; Tzu-Chen Yen ; M.D ; Ph.D.&dagger ; ; # ; yen1110@adm.cgmh.org.tw
- 关键词：Adjuvant radiotherapy ; Oral cavity ; Squamous cell carcinoma ; Survival ; Outcome
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 January 2012
- 年：2012
- 卷：82
- 期：1
- 页码：284-290
- 全文大小：396 K
Purpose
In the American Joint Committee on Cancer 2010 classification system, pT1?N0 oral cavity squamous cell carcinoma (OSCC) is considered an early-stage cancer treatable with surgery alone (National Comprehensive Cancer Network 2010 guidelines). Our aim was to evaluate the feasibility of surgery alone for pT1?N0 OSCC patients.Methods and Materials
Among 1279 previously untreated OSCC patients referred to our hospital between January 1996 and May 2008, we identified 457 consecutive patients with pT1?N0 disease. All had radical tumor excision with neck dissection. A total of 387 patients showing pathologic margins greater than 4 mm and treated by surgery alone were included in the final analysis. All were followed up for at least 24 months after surgery or until death. The 5-year rates of control, distant metastasis, and survival were the main outcome measures.
Results
The 5-year rates in the entire group of pT1?N0 patients were as follows: local control, 91 % ; neck control, 92 % ; distant metastases, 1 % ; disease-free survival, 85 % ; disease-specific survival, 93 % ; and overall survival, 84 % . Multivariate analysis identified poor differentiation and pathologic tumor depth of 4 mm or greater as independent risk factors for neck control, disease-free survival, and disease-specific survival. A scoring system using poor differentiation and tumor depth was formulated to define distinct prognostic groups. The presence of both poorly differentiated tumors and a tumor depth of 4 mm or greater resulted in significantly poorer 5-year neck control (p < 0.0001), disease-free (p < 0.0001), disease-specific (p < 0.0001), and overall survival (p = 0.0046) rates.
Conclusion
The combination of poor differentiation and pathologic tumor depth of 4 mm or greater identified a subset of pT1?N0 OSCC patients with poor outcome, who may have clinical benefit from postoperative adjuvant radiotherapy.