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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Treatment of contralateral N0 neck in early squamous cell carcinoma of the oral tongue: elective neck dissection versus observation.
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Treatment of contralateral N0 neck in early squamous cell carcinoma of the oral tongue: elective neck dissection versus observation.

机译：早期口腔鳞状细胞癌对侧N0颈的治疗：选择性颈清扫与观察。

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OBJECTIVES/HYPOTHESIS: Prophylactic treatment of contralateral N0 neck in early squamous cell carcinoma (SCC) of the oral tongue is a controversial issue. The aim of this study was to analyze the rates of occult metastases and their prognostic effects in stage I and stage II SCC of the oral tongue, and to compare the results of elective neck dissection to observation of the contralateral N0 neck in the treatment of these patients. STUDY DESIGN: Retrospective review. METHODS: We reviewed the medical records of 54 patients who were treated at Severance Hospital from 1992 to 2003 and had been diagnosed with stage I or stage II SCC of the oral tongue and had not received prior treatment. All patients underwent an ipsilateral elective neck dissection simultaneously with the primary lesion. The management of the contralateral N0 necks involved "watchful waiting" in 29 patients and elective neck dissection in 25 patients. Surgical treatment was followed by radiotherapy in 20 patients. Of these, seven patientsbelonged to the "observation" group who did not receive contralateral elective neck dissection. The follow-up period ranged from 3 to 110 months, with a mean of 56.3 months. Data were analyzed using the Kaplan-Meier method, the log-rank test, and the chi(2) test. RESULTS: Fifteen patients (28%, 15 of 54) had occult metastases. Of these, 14 patients (26%, 14 of 54) had ipsilateral pathologic metastases. The remaining case (4%, 1 of 25) had the only contralateral level II occult neck metastasis without ipsilateral metastasis. Disease recurred in 17 of 54 patients (31%). Of these, eight cases (47%, 8 of 17) had regional recurrences. All regional recurrences developed in the ipsilateral neck; there were no cases of contralateral neck recurrence. The 5-year actuarial disease-free survival rates were 82% for the "observation" group and 68% for the elective neck dissection group. This difference was not statistically significant (P = .182). The 5-year actuarial disease-free survival rates were 83% for the "observation" group when those patients who underwent radiotherapy were excluded (n = 22) and 68% for the elective supraomohyoid neck dissection group (n = 25), which showed no statistically significant difference (P = .127). CONCLUSIONS: This study showed that ipsilateral elective neck management is indicated for stage I and II SCC of the oral tongue. On the other hand, our series suggests that contralateral occult lymph node metastasis was unlikely in early-stage oral tongue SCC, and that there was no survival benefit for patients who underwent elective neck dissection in place of observation. Thus, it may not harmful to observe the contralateral N0 neck in the treatment of early oral tongue cancer.
机译：目的/假设：口腔早期鳞状细胞癌（SCC）对侧N0颈部的预防性治疗是一个有争议的问题。这项研究的目的是分析口腔I期和II期SCC的隐匿性转移率及其预后效果，并比较选择性颈淋巴结清扫术和观察对侧N0颈的结果。耐心。研究设计：回顾性审查。方法：我们回顾了1992年至2003年在Severance医院接受治疗的54例患者的病历，这些患者被诊断为口腔I期或II期SCC，并且未接受过治疗。所有患者均在原发病变的同时进行了同侧择期颈淋巴清扫术。对侧N0颈部的处理包括29例患者的“观察等待”和25例患者的择期颈部解剖。手术治疗后放疗20例。在这些患者中，有7例属于“观察”组，没有接受对侧择期颈淋巴清扫术。随访时间为3到110个月，平均56.3个月。使用Kaplan-Meier方法，对数秩检验和chi（2）检验分析数据。结果：15例患者（28％，54例中的15例）有隐匿性转移。在这些患者中，有14例（26％，54例中的14例）有同侧病理转移。其余病例（4％，25分之一）具有唯一的对侧II级隐匿性颈部转移，无同侧转移。 54例患者中有17例复发了疾病（31％）。在这些病例中，有8例（47％，17例中的8例）具有区域性复发。所有区域复发均发生在同侧颈部。没有对侧颈部复发的病例。 “观察”组的5年无精算无病生存率为82％，择期颈清扫术组为68％。这种差异在统计学上不显着（P = .182）。排除接受放射治疗的患者（n = 22），“观察”组的5年无精算无病生存率是83％，而选择性舌上舌骨清扫术组（n = 25）则是68％。无统​​计学差异（P = .127）。结论：这项研究表明，同侧选择性颈部处理适用于口腔舌癌的第一和第二阶段。另一方面，我们的研究表明，早期口腔舌鳞状上皮癌不太可能发生对侧隐匿性淋巴结转移，对于进行选择性颈清扫术代替观察的患者没有生存优势。因此，在早期口腔舌癌的治疗中观察对侧N0颈部可能无害。

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