T4分期后颊癌的手术策略:解剖单位切除  

A new surgical strategy for T4 stage posterior buccal carcinoma: anatomical unit resection

作　　者：吴坤[1,2] 毛元元 吴汉江 Wu Kun;Mao Yuanyuan;Wu Hanjiang(Department of Stomatology,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Oral and Maxillofacial-Head and Neck Oncology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]中南大学湘雅二医院口腔科,长沙410011 [2]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤外科,上海200011

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第9期928-933,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：湖南省卫生健康委员会卫生科研课题(W20243109);中国博士后科学基金(2023M732285);中南大学湘雅二医院新进员工科研启航计划。

摘　　要：目的探讨解剖单位切除方式对T4分期后颊癌患者总生存率的影响。方法回顾性分析2014年3月至2019年12月期间于中南大学湘雅二医院口腔颌面外科诊断为T4分期的79例后颊鳞癌病例,男性74例,女性5例,年龄28~72岁,患者均行颊颌颈联合根治术及股前外侧游离皮瓣修复重建。依据原发灶的处理方式不同进行分组,对照组(40例)患者接受传统扩大切除(1.5~2.0 cm安全边界);试验组(39例)患者接受解剖单位切除,即切除肿瘤累及的整个解剖单位或亚单位。收集患者的临床病理资料并行规律随访,生存率采用Log-rank和Cox比例风险回归模型,多因素分析采用线性回归模型。结果试验组的5年总生存率(61.53%比27.50%)及原发灶控制率(74.36%比27.50%)高于对照组,差异均有统计学意义(χ^(2)=6.624,P=0.010;χ^(2)=17.350,P<0.001)。多元线性回归分析发现,影响原发灶控制率的相关因素有解剖单位切除(t=3.880,P<0.001)和淋巴结转移(t=2.619,P=0.011)。同样,Cox比例风险回归模型分析发现解剖单位切除(Z=2.421,P=0.016)和淋巴结转移(Z=2.793,P=0.005)是影响总生存率的因素。结论对于多解剖区侵犯的后颊癌采用解剖单位切除,可减少局部复发,提高患者的总生存率。Objective:To investigate the effect of anatomical unit resection on the overall survival rate of patients with T4 stage posterior buccal carcinoma.Methods:We conducted a retrospective study on 79 patients with T4 stage posterior buccal squamous cell carcinoma underwent radical surgery for buccal mucosa cancer and reconstruction with free anterolateral thigh flap in the Department of Oral and Maxillofacial Surgery,the Second Xiangya Hospital,Central South University from March 2014 to December 2019.The 74 patients were males and the 5 patients were females,aged from 28 to 72 years old.The 40 patients in control group underwent traditional extended resection(1.5-2.0 cm safe margin),and 39 patients in the experimental group underwent anatomical unit resection.The clinicopathological parameters of patients were collected and followed up regularly.The overall survival rate was assessed by Log-rank and Cox proportional risk regression model.Multivariate analysis was performed by linear regression model.Results:There were significant differences between experimental group and control group in overall survival rates(61.53%vs 27.50%,χ^(2)=6.624,P=0.010)and local disease control rates(74.36%vs 27.50%,χ^(2)=17.350,P<0.001).Multiple linear regression analysis showed that local disease control rate was significantly correlated with anatomical unit resection(t=3.880,P<0.001)and lymph node metastasis(t=2.619,P=0.011),and also Cox proportional hazards regression model analysis identified that overall survival rate was significantly correlated with anatomical unit resection(Z=2.421,P=0.016)and lymph node metastasis(Z=2.793,P=0.005).Conclusion:For posterior buccal carcinoma with multiple anatomical units involved,anatomical unit resection can significantly reduce local recurrence and improve overall survival rate of patients.

关 键 词：口腔肿瘤 颊 解剖单位切除 T4分期后颊癌 生存率 

分 类 号：R739.8[医药卫生—肿瘤]