国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (3): 312-317.doi: 10.7518/gjkq.2021036

• 论著 • 上一篇    下一篇

磁共振成像测量的浸润深度与舌鳞状细胞癌患者颈部淋巴结转移的相关性研究

李明(),原振英,南欣荣()   

  1. 山西医科大学第一医院口腔科 太原 030001
  • 收稿日期:2020-08-12 修回日期:2021-01-22 出版日期:2021-05-01 发布日期:2021-05-14
  • 通讯作者: 南欣荣
  • 作者简介:李明,医师,硕士, Email: limingq248@163.com
  • 基金资助:
    山西省重点研发计划(201803D31094)

Correlation between the depth of invasion measured by magnetic resonance imaging and cervical lymph node metastasis in patients with tongue squamous cell carcinoma

Li Ming(),Yuan Zhenying,Nan Xinrong()   

  1. Dept. of Stomatology, The First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2020-08-12 Revised:2021-01-22 Online:2021-05-01 Published:2021-05-14
  • Contact: Xinrong Nan
  • Supported by:
    Key Research and Development Plan of Shanxi Province(201803D31094)

摘要:

目的 分析磁共振成像(MRI)测量的浸润深度(DOI)与临床颈部淋巴结阴性即cN0期舌鳞状细胞癌患者颈部淋巴结转移的相关性,明确MRI 测量的DOI是否可作为cN0期舌鳞状细胞癌患者颈部淋巴结转移的独立预测因素。方法 经纳入和排除标准筛选后选取61名舌鳞状细胞癌的患者,分析纳入患者中MRI测量的肿瘤DOI及其他临床病理因素(年龄、肿瘤部位、肿瘤T分期、肿瘤分化程度、神经侵犯)与颈部淋巴结转移的关系。结果 61例患者中19例(31%)患者术后病理颈部淋巴结转移阳性(pN+),42例(69%)患者颈部淋巴结转移阴性(pN0)。单因素Logistic回归表明,MRI测量的DOI、T分期及神经侵犯因素与舌鳞状细胞癌患者颈部淋巴结转移有相关性(P<0.05)。多因素Logistic回归表明,仅MRI测量的DOI与颈部淋巴结转移相关(P<0.05)。MRI测量的19例pN+患者DOI均值为(13.2±4.3)mm,42例pN0患者DOI均值为(9.1±4.5)mm,两者差异具有统计学意义(T=3.36,P=0.001)。受试者工作特性曲线(ROC)表明,预测cN0期舌鳞状细胞癌患者颈部淋巴结转移的MRI测量DOI截止值为5.1 mm。结论 MRI测量是预测cN0期舌鳞状细胞癌患者颈部淋巴结转移的独立因素;MRI测量的DOI大于5.1 mm时,cN0期舌鳞状细胞癌患者发生颈部淋巴结转移的风险增加。

关键词: 舌鳞状细胞癌, 浸润深度, 磁共振成像, 颈部淋巴结转移

Abstract:

Objective The correlation between the depth of invasion (DOI) measured by magnetic resonance imaging (MRI) and cervical lymph node metastasis of stage cN0 tongue squamous cell carcinoma was analysed to determine whether the DOI measured by MRI could be used as an independent predictor of cervical lymph node metastasis in stage cN0 tongue squamous cell carcinoma. Methods A total of 61 patients with tongue squamous cell carcinoma were selected after screening using inclusion and exclusion criteria. The relationships between the DOI and other clinicopathological factors (age, tumour site, tumour T stage, tumour differentiation and nerve invasion) and cervical lymph node metastasis measured by MRI in included patients. Results Amongst the 61 patients, 19 (31%) were positive for postoperative pathological cervical lymph node metastasis (pN+) and 42 (69%) were negative for cervical lymph node metastasis (pN0). Single logistic regression showed that the DOI, T stage and nerve invasion factors measured by MRI were correlated with cervical lymph node metastasis in tongue squamous cell carcinoma (P<0.05). Multivariate logistic regression showed that the DOI measured by MRI was correlated with cervical lymph node metastasis (P<0.05). The mean DOI of the 19 pN+ patients measured by MRI was (13.2±4.3) mm, whereas that of the 42 pN0 patients was (9.1±4.5) mm. The difference was statistically significant (T=3.36, P=0.001). The receiver operating characteristic curve showed that the cut-off MRI DOI was 5.1 mm for predicting cervical lymph node metastasis in stage cN0 tongue squamous cell carcinoma. Conclusion The DOI measured by MRI is an independent factor in predicting cervical lymph node metastasis in stage cN0 tongue squamous cell carcinoma. When the DOI measured by MRI was greater than 5.1 mm, the risk of cervical lymph node metastasis increased in stage cN0 tongue squamous cell carcinoma.

Key words: tongue squamous cell carcinoma, depth of invasion, magnetic resonance imaging, cervical lymph node metastasis

中图分类号: 

  • R782

图1

MRI测量舌鳞状细胞癌DOI示意图 A:MRI冠状位;B:MRI横断位。"

表 1

cN0期舌鳞状细胞癌患者颈部淋巴结转移的单因素Logistic回归"

因素 n 淋巴结阳性者 淋巴结阳性率/% P
年龄/岁
>60 36 12 33 0.658
≤60 25 7 28
肿瘤部位
舌缘舌腹 51 15 29 0.376
舌背 10 4 40
T分期
T1 16 3 19 0.035
T2 27 7 26
T3 9 4 44
T4 9 5 56
DOI/mm
≤5 11 1 9 0.015
>5, ≤10 16 3 19
>10 34 15 44
肿瘤分化
高分化 36 11 31 0.509
中分化 17 4 24
低分化 8 4 50
神经侵犯
+ 12 7 58 0.023
- 49 12 24
脉管癌栓
+ 1 1 100
- 60 18 30

表 2

cN0期舌鳞状细胞癌患者颈部淋巴结转移的多因素Logistic回归"

因素 P OR值 OR值的95%CI
下限 上限
DOI/mm
≤5 0.027 0.028 0.001 0.661
>5, ≤10 0.042 0.184 0.036 0.939
>10 0.05
T分期
T1 0.211 5.221 0.393 69.387
T2 0.683 0.783 0.242 2.534
T3 0.839 0.892 0.294 2.702
T4 0.429
神经侵犯 0.137 0.467 0.171 1.274

表 3

MRI测量的DOI与颈部淋巴结转移的关系"

DOI/mm 总数量 pN0组 pN+组
数量 百分比/% 数量 百分比/%
≤5.1 12 11 92 1 8
>5.1 49 31 63 18 37
[1] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015,65(2):87-108.
doi: 10.3322/caac.21262
[2] Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning a management strategy for the stage N0 neck[J]. Arch Otolaryngol Head Neck Surg, 1994,120(7):699-702.
doi: 10.1001/archotol.1994.01880310005001
[3] Atula T, Silvoniemi P, Kurki T, et al. The evaluation and treatment of the neck in carcinoma of the oral cavity[J]. Acta Otolaryngol Suppl, 1997,529:223-225.
[4] Onercl M, Yilmaz T, Gedikoğlu G. Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip[J]. Otolaryngol Head Neck Surg, 2000,122(1):139-142.
doi: 10.1016/S0194-5998(00)70162-8
[5] Al-Rajhi N, Khafaga Y, El-Husseiny J, et al. Early stage carcinoma of oral tongue: prognostic factors for local control and survival[J]. Oral Oncol, 2000,36(6):508-514.
pmid: 11036243
[6] Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature[J]. Head Neck, 2005,27(12):1080-1091.
doi: 10.1002/(ISSN)1097-0347
[7] Yuen AP, Lam KY, Wei WI, et al. A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma[J]. Am J Surg, 2000,180(2):139-143.
pmid: 11044531
[8] Lam P, Au-Yeung KM, Cheng PW, et al. Correlating MRI and histologic tumor thickness in the assessment of oral tongue cancer[J]. AJR Am J Roentgenol, 2004,182(3):803-808.
doi: 10.2214/ajr.182.3.1820803
[9] Alsaffar HA, Goldstein DP, King EV, et al. Correlation between clinical and MRI assessment of depth of invasion in oral tongue squamous cell carcinoma[J]. J Otolaryngol Head Neck Surg, 2016,45(1):61.
doi: 10.1186/s40463-016-0172-0
[10] 尚伟, 郑家伟. 口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读[J]. 中国口腔颌面外科杂志, 2018,16(6):533-546.
Shang W, Zheng JW. Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx[J]. China J Oral Maxillofac Surg, 2018,16(6):533-546.
[11] Shintani S, Nakayama B, Matsuura H, et al. Intraoral ultrasonography is useful to evaluate tumor thickness in tongue carcinoma[J]. Am J Surg, 1997,173(4):345-347.
pmid: 9136794
[12] 冉慕光, 王承光, 陈圣欢. 舌癌影像解剖特点及MRI征象分析[J]. 临床放射学杂志, 2016,35(7):1023-1026.
Ran MG, Wang CG, Chen SH. Role of MRI in describing anatomy of tongue carcinoma and evaluating imaging feature[J]. J Clin Radiol, 2016,35(7):1023-1026.
[13] Preda L, Chiesa F, Calabrese L, et al. Relationship between histologic thickness of tongue carcinoma and thickness estimated from preoperative MRI[J]. Eur Radiol, 2006,16(10):2242-2248.
doi: 10.1007/s00330-006-0263-9
[14] Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity[J]. Cancer, 1990,66(1):109-113.
doi: 10.1002/(ISSN)1097-0142
[15] Woolgar JA. Histological distribution of cervical lymph node metastases from intraoral/oropharyngeal squamous cell carcinomas[J]. Br J Oral Maxillofac Surg, 1999,37(3):175-180.
doi: 10.1054/bjom.1999.0036
[16] Yang X, Tian XR, Wu KL, et al. Prognostic impact of perineural invasion in early stage oral tongue squamous cell carcinoma: Results from a prospective randomized trial[J]. Surg Oncol, 2018,27(2):123-128.
doi: S0960-7404(17)30388-2 pmid: 29937161
[17] Mücke T, Mitchell DA, Wagenpfeil S, et al. Incidence and outcome for patients with occult lymph node involvement in T1 and T2 oral squamous cell carcinoma: a prospective study[J]. BMC Cancer, 2014,14:346.
doi: 10.1186/1471-2407-14-346
[18] Tam S, Amit M, Zafereo M, et al. Depth of invasion as a predictor of nodal disease and survival in patients with oral tongue squamous cell carcinoma[J]. Head Neck, 2019,41(1):177-184.
[19] Jung J, Cho NH, Kim J, et al. Significant invasion depth of early oral tongue cancer originated from the lateral border to predict regional metastases and prognosis[J]. Int J Oral Maxillofac Surg, 2009,38(6):653-660.
doi: 10.1016/j.ijom.2009.01.004
[20] Kwon M, Moon H, Nam SY, et al. Clinical significance of three-dimensional measurement of tumour thickness on magnetic resonance imaging in patients with oral tongue squamous cell carcinoma[J]. Eur Radiol, 2016,26(3):858-865.
doi: 10.1007/s00330-015-3884-z
[21] Goel V, Parihar PS, Parihar A, et al. Accuracy of MRI in prediction of tumour thickness and nodal stage in oral tongue and gingivobuccal cancer with clinical correlation and staging[J]. J Clin Diagn Res, 2016,10(6):TC01-TC05.
[22] Park JO, Jung SL, Joo YH, et al. Diagnostic accuracy of magnetic resonance imaging (MRI) in the assessment of tumor invasion depth in oral/oropharyngeal cancer[J]. Oral Oncol, 2011,47(5):381-386.
doi: 10.1016/j.oraloncology.2011.03.012
[23] Yesuratnam A, Wiesenfeld D, Tsui A, et al. Preoperative evaluation of oral tongue squamous cell carcinoma with intraoral ultrasound and magnetic resonance imaging-comparison with histopathological tumour thickness and accuracy in Guiding patient management[J]. Int J Oral Maxillofac Surg, 2014,43(7):787-794.
doi: 10.1016/j.ijom.2013.12.009
[24] 刘华, 李龙江, 代晓明. 口腔癌引流区淋巴结反应性增生与微转移关系的研究[J]. 实用口腔医学杂志, 2007,23(3):400-403.
Liu H, Li LJ, Dai XM. A study on the relationship between reactive hyperplasia of the draining lymph nodes and oral cancer micrometastasis[J]. J Pract Stomatol, 2007,23(3):400-403.
[1] 吴南,李斌. 吡咯喹啉醌对舌鳞状细胞癌细胞上皮间质转化的抑制作用研究[J]. 国际口腔医学杂志, 2020, 47(4): 406-412.
[2] 刘彤曦,柯星,杨健. 磁共振成像及其在牙体牙髓专业中的应用[J]. 国际口腔医学杂志, 2019, 46(6): 693-698.
[3] 邓程丹,石冰,李杨. 唇腭裂患者的脑部结构与功能研究进展[J]. 国际口腔医学杂志, 2019, 46(5): 617-620.
[4] 王志强,刘娅丽,马丽娟,杨兰,王若宇,高舒婷. 红景天苷对人舌鳞状细胞癌CAL-27细胞增殖、凋亡、周期及迁移的影响[J]. 国际口腔医学杂志, 2018, 45(6): 678-685.
[5] 王丽萍, 查骏, 葛林虎. 非编码RNA在舌鳞状细胞癌中的研究进展[J]. 国际口腔医学杂志, 2018, 45(4): 420-424.
[6] 秦琨1 张东坡2. 不同材料烤瓷冠与金属冠磁共振成像伪影的比较[J]. 国际口腔医学杂志, 2016, 43(5): 507-510.
[7] 吕春晓 陈嵩. 颞下颌关节病的临床诊断与磁共振成像影像诊断的相关性研究[J]. 国际口腔医学杂志, 2016, 43(1): 47-.
[8] 吴开柳 李思毅 张陈平. 舌鳞状细胞癌颈淋巴结转移的特点和评估处理[J]. 国际口腔医学杂志, 2015, 42(1): 119-122.
[9] 王晓彦1 武云霞2. 尼美舒利对人舌鳞状细胞癌Tca8113细胞ang-2基因表达的影响[J]. 国际口腔医学杂志, 2011, 38(6): 646-648.
[10] 冯正虎, 李春青, 王凌, 韩冰, 聂红兵, 苏雪莲. 血管内皮生长因子-C 在不同浸润方式的舌鳞状细胞癌中的表达[J]. 国际口腔医学杂志, 2011, 38(1): 7-9.
[11] 史琦综述王燕一审校. 口腔内金属对头颅磁共振成像的影响和减少伪影方法的研究进展[J]. 国际口腔医学杂志, 2010, 37(6): 711-713.
[12] 赵芳综述 刘东旭审校. 功能性磁共振在口腔医学中的应用[J]. 国际口腔医学杂志, 2009, 36(5): 586-589.
[13] 霍秋菊综述 李伟忠审校. 环氧化酶-2 及其选择性抑制剂塞来昔布与舌鳞状细胞癌侵袭的研究进展[J]. 国际口腔医学杂志, 2009, 36(3): 344-346,350.
[14] 严少文综述 刘丽审校. 减少金属修复体在磁共振成像中伪影的研究进展[J]. 国际口腔医学杂志, 2008, 35(6): 712-712~714.
[15] 杨秀文综述 刘洪臣审校. 口腔唇、舌、牙齿在大脑躯体感觉皮层的定位[J]. 国际口腔医学杂志, 2008, 35(5): 529-529~530.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 陆加梅. 不可复性关节盘移位患者术前张口度与关节镜术后疗效的相关性[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 陈晓 蒋文晖 王文梅. 念珠菌性白斑的研究概况[J]. 国际口腔医学杂志, 2004, 31(02): 138 -140 .
[3] 吴卫锋 雷丹 姜苏 高雳. 安止痛牙龈膏对牙龈卟啉单胞菌和伴放线嗜血菌及具核梭杆菌的抑菌作用[J]. 国际口腔医学杂志, 2011, 38(2): 138 -140 .
[4] 房俊艳综述 凌均棨审校 . 树脂单体毒性机制的研究进展[J]. 国际口腔医学杂志, 2010, 37(3): 302 -302~305 .
[5] 陈哂媛1,巢永烈1,邓咏梅2,陈超3,李苑1,张书垣1. 成都市老年人可摘局部义齿戴用情况和修复效果调查[J]. 国际口腔医学杂志, 2010, 37(4): 396 -399 .
[6] 黄文青综述 杨健审校. 龋病影响牙本质自酸蚀粘接修复的研究进展[J]. 国际口腔医学杂志, 2011, 38(5): 600 -602 .
[7] 宋文婷1 刘光涛2 隋秋丽3 陈渊3 葛林3 林梅3. 音乐对味觉辨别阈的影响[J]. 国际口腔医学杂志, 2013, 40(4): 459 -461 .
[8] 别筝1,2 郑凌艳1综述 俞创奇1审校. 唾液腺分泌减少的原因分析及功能评价[J]. 国际口腔医学杂志, 2013, 40(4): 476 -479 .
[9] 叶欣 杨丕山. 冠心病与牙周炎间的临床和生物学相关性研究[J]. 国际口腔医学杂志, 2013, 40(3): 323 -325 .
[10] 杨宏丽 刘思茗综述 胡涛审校. 低温等离子体技术在口腔临床消毒中的应用[J]. 国际口腔医学杂志, 2013, 40(4): 483 -485 .