中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2022, Vol. 20 ›› Issue (6): 571-576.doi: 10.19438/j.cjoms.2022.06.009

• 论著 • 上一篇    下一篇

第8版TNM分期修订版对早期口腔黏膜鳞癌患者预后及危险分层作用的临床研究

周瑜1, 翁海燕2, 司呈云1, 段贤捷1, 安星妃1, 章礼玉1   

  1. 1.中国科学技术大学附属第一医院（安徽省立医院） 口腔颌面外科,2.病理科,安徽 合肥 230001
  • 收稿日期:2022-03-14 修回日期:2022-06-03 出版日期:2022-11-20 发布日期:2022-11-20
  • 通讯作者: 周瑜,E-mail: zyugj@sina.com
  • 作者简介:周瑜（1979-）,男,博士,副主任医师

Clinical study on the prognostic and risk stratification effect of the 8th revised TNM staging on patients with early oral squamous cell carcinoma

ZHOU Yu1, WENG Hai-yan2, SI Cheng-yun1, DUAN Xian-jie1, AN Xing-fei1, ZHANG Li-yu1   

  1. 1. Department of Oral, Maxillofacial Surgery,2. Department of Pathology, The First Affiliated Hospital of University of Science, Technology of China. Hefei230001, Anhui Province, China
  • Received:2022-03-14 Revised:2022-06-03 Online:2022-11-20 Published:2022-11-20

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摘要： 目的 了解第8版TNM分期修订版对早期口腔黏膜鳞癌危险分层及预后的作用。方法 回顾2008年11月—2016年12月间在中国科学技术大学附属第一医院接受手术治疗的104例早期口腔黏膜鳞癌患者,分析第8版TNM分期修订版引起的分期迁移变化对患者危险分层的作用及对预后的影响。采用SPSS 23.0软件包对数据进行统计学分析。结果 早期口腔癌患者的肿瘤浸润深度与预后显著相关。第7版pT1期70例患者中,39例升级为第8版pT2期;升级与未升级患者间术后复发存在显著差异（P<0.001）,但颈淋巴结转移无统计学差异（P=0.1169）。第7版pT2期34例患者中,17例升级至第8版的pT3期;升级和未升级患者间,术后复发和颈淋巴结转移无统计学差异（P>0.05）。第7版各分期在总体生存率上存在显著差异（P=0.046）,但疾病特异性（别）生存率的差异无统计学意义（P=0.242）。第8版各分期的总体生存率（P<0.001）和疾病特异性生存率（P<0.001）存在显著差异。结论 肿瘤浸润深度的增加,预示着早期口腔癌患者临床预后的恶化。相比第7版,第8版TNM分期修订版对早期口腔癌患者具有更好的预后和危险分层能力。对pT2以上的患者应施行包括同期选择性颈淋巴清扫术在内的更为广泛的手术治疗,术后辅助治疗可提高患者生存率。

关键词: 口腔癌, 鳞状细胞癌, 浸润深度, 淋巴结外扩展, TNM分期

Abstract: PURPOSE: To understand the effect of the 8th revised TNM staging on the risk stratification and prognosis of early oral mucosal squamous cell carcinoma (OSCC). METHODS: One hundred and four patients with early OSCC who underwent surgery in our hospital from November 2008 to December 2016 were reviewed, and the effect of stage migration caused by the revised version of TNM stage 8 on the risk stratification and prognosis of patients was analyzed. SPSS 23.0 software package was used for data analysis. RESULTS: The depth of tumor invasion in patients with early OSCC was significantly correlated with the prognosis. Thirty-nine of 70 patients with pT1 in the 7th edition were upgraded to pT2 in the 8th edition. There was significant difference in postoperative recurrence between upgraded and non-upgraded patients (P<; 0.001), but there was no significant difference in cervical lymph node metastasis(P=0.1169). Seventeen of the 34 patients with pT2 in the 7th edition were upgraded to pT3 in the 8th edition. There was no significant difference in postoperative recurrence and cervical lymph node metastasis between upgraded and non-upgraded patients(P>; 0.05). There was significant difference in the overall survival rate among the stages of the 7th edition (P=0.046), but there was no significant difference in the disease-specific survival rate (P=0.242). There were significant differences in the overall survival rate (P<; 0.001) and disease-specific survival rate (P<; 0.001) among the stages of the 8th edition. CONCLUSIONS: The increase of tumor invasion depth indicates the deterioration of clinical prognosis in patients with early OSCC. Compared with the 7th edition, the 8th edition of TNM staging revision has better prognosis and risk stratification ability for patients with early OSCC. For patients with pT2 or above, more extensive surgical treatment including simultaneous selective neck dissection should be performed. Postoperative adjuvant treatment can improve the survival rate of patients.

Key words: Oral cancer, Squamous cell carcinoma, Depth of invasion, Extranodal extension, TNM stage

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