2种下颌骨切除方式对口腔鳞癌预后的影响

摘要/Abstract

摘要： 目的:分析比较2种不同下颌骨切除术式对口腔鳞癌预后的影响,探讨影响复发率的因素。方法:回顾2001年1月—2015年1月由同一组医师实施的82例涉及下颌骨的口腔癌手术,其中39例行下颌骨边缘性切除,43例行下颌骨节段性切除。采用SPSS19.0软件包对2种手术方式的复发率、生存率进行Kaplan-Meier分析和Log-rank检验,采用Cox回归模型进行单因素和多因素生存分析。结果:下颌骨边缘性切除组3年复发率为29.1%,下颌骨节段性切除组为18.4%,2组之间无显著差异（P=0.165）;下颌骨边缘性切除组的5年复发率为39.7%,节段性切除组为34.2%,2组之间无显著差异（P=0.460）。边缘性切除组3年生存率为75.2%,节段性切除组为69.2%,2组之间比较无显著差异（P=0.263）;边缘性切除组5年生存率为55.5%,节段性切除组为60.7%,2组之间无显著差异（P=0.816）。Cox多因素分析表明,低分化是术后局部复发的唯一高危因素（P=0.001）。结论:对合适的病例采取下颌骨边缘性切除,是安全、有效的手术方法。对低分化患者,应更加注意术后随访。

关键词: 口腔鳞癌, 下颌骨切除, 预后分析

Abstract: PURPOSE: To compare the different prognosis between marginal mandibulectomy（MG）and segmental mandibulectomy（SG）for oral squamous cell carcinoma (OSCC) and investigate the influential factors of prognosis. METHODS: Eighty-two oral carcinoma operations involving mandibulectomy (between January 2001 and January 2015) were evaluated retrospectively. Of the 82 patients, 39 had marginal mandibulectomy,43 had segmental mandibulectomy. The local recurrent rate and survival rate of these 2 treatment modalities were analyzed by Kaplan-Meier using SPSS 19.0 software package. Cox regression model was used to determine the risk factors for recurrence. RESULTS: Three-year and 5-year local recurrent rate was 29.1% and 39.7% in MG group, and 18.4%, 34.2% respectively in SG group. The local recurrent rate between the two groups had no significant difference (P>0.05). Three-year and 5-year survival rate was 75.2%t and 55.5% in MG group, and 69.2%, 60.7% respectively in SG group. There was no significant difference between the two groups (P>0.05). Lowly differentiated pathologic type was the only influential factor for prognosis in multivariate Cox regression analysis（P=0.001）. CONCLUSIONS: Marginal mandibulectomy is a safe and effective operative in appropriate cases. For patients with lowly differentiated OSCC, close follow-up is more important for early detection of recurrence.

Key words: Oral squamous cell carcinoma, Mandible mandibulectomy, Prognosis analysis

中图分类号:

R739.8

邱宇, 林李嵩, 施斌, 朱小峰, 黄立, 黄跃, 廖云阳. 2种下颌骨切除方式对口腔鳞癌预后的影响[J]. 中国口腔颌面外科杂志, 2016, 14(2): 149-153.

QIU Yu, LIN Li-song, SHI Bin, ZHU Xiao-feng, HUANG Li, HUANG Yue, LIAO Yun-yang. A preliminary study on different prognoses of oral squamous cell carcinoma treated with marginal mandibulectomy and segmental mandibulectomy[J]. China J Oral Maxillofac Surg, 2016, 14(2): 149-153.

参考文献

[1] Southam JC. The extension of squamous carcinoma along the inferior dental neurovascular bundle [J]. Br J Oral Surg, 1970, 7(3): 137-145.
[2] Marchetta FC, Sako K, Murphy JB. The periosteum of the mandible and intraoral carcinoma [J]. Am J Surg, 197l, 122(6): 711-713.
[3] McGregor IA, MacDonald DG. Spread of squamous cell carcinoma to the nonirradiated edentulous mandible a preliminary repot [J]. Head Neck Surg, 1987, 9(3): l57-161.
[4] Brown JS, Lowe D, Kalavrezos N, et al. Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma [J]. Head Neck, 2002, 24(4): 370-383.
[5] Genden EM, Rinaldo A, Jacobson A, et al. Management of mandibular invasion: when is a marginal mandibulectomy appropriate? [J]. Oral Oncol, 2005, 41(8): 776-782.
[6] Wax MK, Bascom DA, Myers LL. Marginal mandibulectomy vs segmental mandibulectomy: indications and controversies [J]. Arch Otolaryngol Head Neck Surg, 2002, 128(5): 600-606.
[7] Perl TZ. Segmental sagittal splitting of the mandible in the surgical treatment of the floor of the mouth [J]. J Oral Surg, 1972,30(9): 656-657.
[8] Flynn MB, Moore C. Marginal resection of the mandible in the management of squamous cancer of the floor of the mouth [J].Am J Surg, 1974, 128(4): 490-493.
[9] Brusati R, Bottazzi D. En bloc cortical resection in the treatment of paramandibular carcinomas [J]. J Maxillofac Surg, 1978, 6(1): 50-59.
[10] Tsue TT, McCulloth MT, Girod DA, et al. Predictors of carcinomatous invasion of the mandible [J]. Head Neck, 1994,16(2): 116-126.
[11] McGregor AD, MacDonald DG. Patterns of spread of squamous cell carcinoma to the ramus of the mandible [J]. Head Neck, 1993, 15(5): 440-444.
[12] Politi M, Costa F, Robiony M, et a1. Review of segmental and marginal resection of the mandible in patients with oral cancer [J]. Acta Otolaryngol, 2000, 120(5): 569-579.
[13] O'Brien CJ, Adams JR, McNeil EB, et al. Influence of bone invasion and extent of mandibular resection on local control of cancers of the oral cavity and oropharynx [J].Int J Oral Maxillofac Surg, 2003, 32(5): 492-497.
[14] Tei K, Totsuka Y, lizuka T, et al. Marginal resection for carcinoma of the mandibular alveolus and gingiva where radiologically detected bone defects do not extend beyond the mandibular canal [J]. J Oral Maxillofac Surg, 2004, 62(7): 834-839.
[15] Patel RS, Dirven R, Clark JR, et al. The prognostic impact of extent of bone invasion and extent of bone resection in oral carcinoma [J]. Laryngoscope,2008,118(5): 780-785.
[16] Pandey M, Rao LP, Das SR, et al. Tumor stage and resection margins not the mandibular invasion determines the survival in patients with cancers of oro-mandibular region [J]. Eur J Surg Oncol, 2009, 35(12): 1337-1342.
[17] Imai Y, Yamanaka Y, Aoki K, et al.Alveolar ridge reconstruction following marginal mandibulectomy on carcinoma of the lower gingiva and alveolus [J].Oral Oncol,2011,47（Suppl）:S140.
[18] Rao LP, Shukla M, Sharma V, et al. Mandibular conservation in oral cancer [J]. Surg Oncol, 2012, 21(2): 109-118.
[19] Ahuja RB, Soutar DS, Moule B, et al. Comparative study of technetium -99m bone scans and orthopantomography in determining mandible invasion in intraoral squamous cell carcinoma [J]. Head Neck,1990, 12(3): 237-243.
[20] Deepanandan L, Narayanan V, Baig MF. Mandibular invasion of squamous cell carcinoma: factors determining surgical resection of mandible using computerized tomography and histopathologic study [J]. J Maxillofac Oral Surg, 2010, 9(1): 48-53.
[21] 安常明, 张彬. 口腔口咽鳞状细胞癌侵犯下颌骨的诊断及术式选择 [J]. 国际耳鼻喉头颈外科杂志, 2007, 31(2): 111-114.
[22] 张莉华, 谢文晖, 俞文昌. 1500例肺癌患者核素骨显像结果分析[J].中华核医学杂志, 1999, 19(1): 8-9.
[23] Lane AP, Buckmire RA, Mukheqi SK, et al. Use of computed tomography in the assessment of mandibular invasion in carcinoma of the retromolar trigone [J]. Otolaryngol Head Neck Surg, 2000, 122(5): 673-677.
[24] Acton CH, Layt C, Gwynne R, et al. Investigative modalities of mandibular invasion by squamous cell carcinoma [J]. Laryngoscope, 2000, 110(12): 2050-2055.
[25] Mukherji SK, Isaacs DL, Creager A, et al. CT detection of mandibular invasion by squamous cell carcinoma of the oral cavity [J]. AJR Am J Roentgenol, 2001, 177(1): 237-243.
[26] Yamamoto Y, Nishiyama Y, Satoh K, et al. Dual-isotope SPECT using 99m Tc-hydroxymethylene diphosphonate and 201 Tl-chloride to assess mandibular invasion by intraoral squamous cell carcinoma [J]. J Nucl Med, 2002, 43(11): 1464-1468.
[27] Brown JS, Griffith JF, Phelps PD, et al. A comparison of different imaging modalities and direct inspection after periosteal stripping in predicting the invasion of the mandible by oral squamous cell carcinoma [J]. Br J Oral Maxillofac Surg, 1994, 32(6): 347-359.
[28] Forrest LA, Schuller DE, Lucas JG, et al. Rapid analysis of mandibular margins [J]. Laryngoscope 1995, 105(5 Pt 1): 475-477.
[29] Bilodeau EA, Chiosea S. Oral squamous cell carcinoma with mandibular bone invasion: intraoperative evaluation of bone margins by routine frozen section [J]. Head and Neck Pathol, 2011, 5(3): 216-220.
[30] Wysluch A, Stricker I, Holzle F, et al. Intraoperative evaluation of bony margins with frozen-section analysis and trephine drill extraction technique: a preliminary study [J]. Head Neck, 2010, 32(11): 1473-1478.
[31] Bova RJ, Quinn DI, Nankervis JS, et al. Cyclin D1 and p16INK4A expression predict reduced survival in carcinoma of anterior tongue [J]. Clin Cancer Res, 1999, 5(10): 2810-2819.
[32] Loree TR, Mullins AP, Spdlman J, et al. Head and neck mucosal melanoma: a 32-year review [J]. Ear Nose Throat J, 1999, 78(5): 372-375.
[33] Spiro RH, Guillamondegui O Jr, Paulino AF, et al. Pattern of invasion and margin assessment in patients with oral tongue cancer [J]. Head Neck, 1999, 21(5): 408-413.
[34] Jones KR, kodge-Rigal RD, Reddick RL, et al. Prognostic factors in the recurrence of stage Ⅰ and Ⅱ squamous cell cancer of the oral cavity [J]. Arch Otdaryngol Head Neck Surg, 1992, 118(5): 483-485.