上颌鳞状细胞癌临床颈部淋巴结阴性患者的治疗  

Treatment of patients with negative cervical lymph nodes in maxillary squamous cell carcinoma

作　　者：李珊 陈林林[1] Li Shan;Chen Linlin(Dept.of Oral and Maxillofacial Surgery,Affiliated Stomatological Hospital of Nanchang University,The Key Laboratory of Oral Biomedicine in Jiangxi Province,Nanchang 330000,China)

机构地区：[1]南昌大学附属口腔医院口腔颌面外科,江西省口腔生物医学重点实验室,南昌330000

出　　处：《国际口腔医学杂志》2021年第4期444-449,共6页International Journal of Stomatology

摘　　要：原发于上颌牙龈和硬腭的上颌鳞状细胞癌(MSCC)是一种相对较少见的头颈部肿瘤,患病率相对较低,病例收集难度较大,因此目前有关MSCC颈部淋巴结阴性患者治疗和预后的研究仍然较少,且其临床治疗策略存在争议,国际上也无统一的治疗指导策略。目前的研究显示:MSCC患者颈部淋巴结的总转移率为21%~46.1%,主要影响因素有肿瘤分期、分化程度、肿瘤位置、神经血管侵犯及骨浸润等;MSCC的5年生存率为32%~70.8%,主要影响因素有颈部淋巴结转移、肿瘤位置、选择性颈部淋巴结清扫等;MSCC存在对侧及双侧转移的风险,颈部复发率可达33%,且挽救性手术成功率低。根据目前的研究成果,推荐T3/T4期临床颈部淋巴结阴性患者行选择性颈部淋巴结清扫,并建议后续设计更多前瞻性、大样本量的研究,增强结果的可靠性,为临床治疗提供参考。Maxillary squamous cell carcinoma(MSCC)with primary maxillary gingiva and hard palate is a relatively rare head and neck tumor.Considering the low incidence and the difficulty of case collection,only few studies focused on the clinical cervical lymph node-negative patients of MSCC.The related clinical treatment strategies are controversial,and a unified treatment guidance strategy remains lacking worldwide.The total rate of cervical lymph node metastasis in patients with MSCC is 21%–46.1%.The main influencing factors are tumor stage,degree of differentiation,location,neurovascular invasion,and bone infiltration.The 5-year survival rate of MSCC is 32%–70.8%.The main influencing factors are cervical lymph node metastasis,location,selective cervical lymph node dissection,and so on.MSCC has the risk of contralateral and bilateral metastases,the neck recurrence rate can reach 33%,and the success rate of salvage surgery is low.Selective neck dissection is recommended for patients with negative cervical lymph nodes in the T3/4 stage.A prospective,large-scale study is necessary to enhance the reliability of the results and provide powerful references for clinical treatment.

关 键 词：上颌牙龈 硬腭 鳞状细胞癌 颈部淋巴结转移 颈部淋巴结清扫 

分 类 号：R730.56[医药卫生—肿瘤]