Otolaryngol Head Neck Surg. 2007 Apr;136(4 Suppl):S41-5
Santa Maria PL, Sader C, Preston NJ, Fisher PH.
Department of Ear, Nose, and Throat Surgery, Fremantle Hospital, Perth, Western Australia, Australia; Department of Psychiatry, Fremantle Hospital, Perth, Western Australia, Australia.
OBJECTIVES: To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone. STUDY DESIGN: A retrospective, 14-year surgical audit. METHODS: The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model. RESULTS: The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year. CONCLUSIONS: Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.
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Neck dissection for squamous cell carcinoma of the head and neck.
颈清扫术治疗头颈部鳞状细胞癌
Otolaryngol Head Neck Surg. 2007 Apr;136(4 Suppl):S41-5
Santa Maria PL, Sader C, Preston NJ, Fisher PH.
Department of Ear, Nose, and Throat Surgery, Fremantle Hospital, Perth, Western Australia, Australia; Department of Psychiatry, Fremantle Hospital, Perth, Western Australia, Australia.
OBJECTIVES: To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone.
目的：研究多个头颈临床中心172例鳞状细胞癌患者接受颈清扫术的成功和失败经验，并观察手术失败（死于头颈部癌或局部复发）或仅有局部复发的预测因素。
STUDY DESIGN: A retrospective, 14-year surgical audit.
实验设计：14年手术结果的回顾性分析。
METHODS: The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model.
方法：患者病史中的信息与数据库相关联，应用logistic回归模型进行多因素分析。
RESULTS: The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year.
结果：头颈部最常发生鳞状细胞癌的部位是口腔（42%），17%的肿瘤患者原发病灶不明。5年后的无瘤生存率为76.7%。那些年龄较大的、无抽烟史者或没有对原发病灶实施放疗者更容易死于头颈部肿瘤或出现局部复发（P<0.1）。根治性清扫患者在生存率或局部复发率上并没有更好的结果。淋巴结侵犯的出现是惟一重要的预测局部复发的因素（P=0.1），其中67%的患者出现在术后第一年。
CONCLUSIONS: Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.
结论：与吸烟有关的鳞状细胞癌患者的病变侵袭性较小。联合放疗在头颈部鳞状细胞癌患者的治疗中具有重要意义。随访尤其是术后第一年是处理头颈部肿瘤所必需的。头颈外科医生不必采用根治性的颈清扫术。
颈清扫术治疗头颈部鳞状细胞癌
目的：研究多个头颈临床中心172例鳞状细胞癌患者接受颈清扫术的成功和失败经验，并观察手术失败（死于头颈部癌或局部复发）或仅有局部复发的预测因素。实验设计：14年手术结果的回顾性分析。方法：与数据库相关联的患者病史中的信息，应用logistic回归模型进行多因素分析。结果：头颈部最常发生鳞状细胞癌的部位是口腔（42%），17%的肿瘤患者原发病灶不明。5年后的无瘤生存率为76.7%。那些年龄较大的、无抽烟史者或没有对原发病灶实施放疗者更容易死于头颈部肿瘤或出现局部复发（P<0.1）。更积极的根治性清扫患者在生存率或局部复发率上并没有更好的结果。淋巴结侵犯的出现是惟一重要的预测局部复发的因素（P=0.1），其中67%的局部复发患者出现在术后第一年。结论：与吸烟有关的鳞状细胞癌患者的病变侵袭性较小。联合放疗在头颈部鳞状细胞癌患者的治疗中具有重要意义。必需重视头颈部肿瘤患者的随访，尤其是术后第一年。头颈外科医生没有必要采用更积极的根治性颈清扫术。
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