国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (4): 444-449.doi: 10.7518/gjkq.2021077

• 综述 • 上一篇    下一篇

上颌鳞状细胞癌临床颈部淋巴结阴性患者的治疗

李珊(),陈林林()   

  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
  • 收稿日期:2021-01-05 修回日期:2021-04-07 出版日期:2021-07-01 发布日期:2021-06-30
  • 通讯作者: 陈林林
  • 作者简介:李珊,硕士,Email： 11606019129@qq.com

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

Li Shan(),Chen Linlin()   

  1. Dept. of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanchang University, The Key Laboratory of Oral Biomedicine in Jiangxi Province, Nanchang 330000, China
  • Received:2021-01-05 Revised:2021-04-07 Online:2021-07-01 Published:2021-06-30
  • Contact: Linlin Chen

RichHTML

12

PDF (PC)

120

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。

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

Abstract:

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.

Key words: maxillary gingiva, hard palate, squamous cell carcinoma, cervical lymph node metastasis, cervical lymph node dissection

中图分类号: 

  • R730.56
[1] 孙乾, 章文博, 高敏, 等. cN0上颌恶性肿瘤颈淋巴结转移的临床分析[J]. 北京大学学报(医学版), 2017,49(6):1050-1054.
Sun Q, Zhang WB, Gao M, et al. Clinical analysis of cervical lymph node metastasis of cN0 maxillary malignant tumor[J]. J Peking Univ (Heal Sci), 2017,49(6):1050-1054.
[2] 杨子楠, 梁倩, 邓润智, 等. 上颌鳞癌的颈淋巴转移与预后分析[J]. 实用口腔医学杂志, 2014,30(6):764-769.
Yang ZN, Liang Q, Deng RZ, et al. Cervical metas-tases and prognosis of oral maxillary squamous cell carcinoma: a retrospective study[J]. J Pract Stomatol, 2014,30(6):764-769.
[3] Zhang WB, Wang Y, Mao C, et al. Cervical metastasis of maxillary squamous cell carcinoma[J]. Int J Oral Maxillofac Surg, 2015,44(3):285-291.
doi: 10.1016/j.ijom.2014.10.020
[4] Lin HW, Bhattacharyya N. Survival impact of nodal disease in hard palate and maxillary alveolus cancer[J]. Laryngoscope, 2009,119(2):312-315.
doi: 10.1002/lary.v119:2
[5] Sundermann BV, Uhlmann L, Hoffmann J, et al. The localization and risk factors of squamous cell carcinoma in the oral cavity: a retrospective study of 1 501 cases[J]. J Craniomaxillofac Surg, 2018,46(2):177-182.
doi: S1010-5182(17)30369-4 pmid: 29242026
[6] Brown JS, Bekiroglu F, Shaw RJ, et al. Management of the neck and regional recurrence in squamous cell carcinoma of the maxillary alveolus and hard palate compared with other sites in the oral cavity[J]. Head Neck, 2013,35(2):265-269.
doi: 10.1002/hed.v35.2
[7] Deneuve S, Bodard AG, Delquignies E, et al. Can early dissection of cervical lymph nodes improve prognosis in squamous cell carcinomas of the hard palate[J]. ORL J Otorhinolaryngol Relat Spec, 2017,79(6):314-322.
doi: 10.1159/000480351
[8] Siriwardena BS, Rasnayaka RM, Masood Y, et al. Predictive model of oral cancer metastasis for different cancer sites and age groups[J]. J Investig Clin Dent, 2016,7(2):127-131.
doi: 10.1111/jicd.12145
[9] 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
[10] Poeschl PW, Seemann R, Czembirek C, et al. Impact of elective neck dissection on regional recurrence and survival in cN0 staged oral maxillary squamous cell carcinoma[J]. Oral Oncol, 2012,48(2):173-178.
doi: 10.1016/j.oraloncology.2011.09.006
[11] Yang XM, Song XM, Chu WM, et al. Clinicopathological characteristics and outcome predictors in squamous cell carcinoma of the maxillary gingiva and hard palate[J]. J Oral Maxillofac Surg, 2015,73(7):1429-1436.
doi: 10.1016/j.joms.2014.12.034
[12] Qu Y, Liu YB, Su M, et al. The strategy on managing cervical lymph nodes of patients with maxillary gingival squamous cell carcinoma[J]. J Craniomaxillofac Surg, 2019,47(2):300-304.
doi: 10.1016/j.jcms.2018.12.008
[13] Feng ZE, Li JN, Li CZ, et al. Elective neck dissection versus observation for cN0 neck of squamous cell carcinoma primarily located in the maxillary gingiva and alveolar ridge: a retrospective study of 129 cases[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013,116(5):556-561.
doi: 10.1016/j.oooo.2013.07.011
[14] Beltramini GA, Massarelli O, Demarchi M, et al. Is neck dissection needed in squamous-cell carcinoma of the maxillary gingiva, alveolus, and hard palate? A multicentre Italian study of 65 cases and literature review[J]. Oral Oncol, 2012,48(2):97-101.
doi: 10.1016/j.oraloncology.2011.08.012
[15] Moreno-Sánchez M, González-García R, González-Ballester D, et al. What is the role of elective neck dissection in patients with squamous cell carcinoma of the upper jaw[J]. Revista Española De Cirugía Oral y Maxilofacial, 2017,39(1):22-27.
doi: 10.1016/j.maxilo.2016.02.003
[16] Berger M, Grau E, Saure D, et al. Occurrence of cervical lymph node metastasis of maxillary squamous cell carcinoma‒A monocentric study of 171 patients[J]. J Craniomaxillofac Surg, 2015,43(10):2195-2199.
doi: 10.1016/j.jcms.2015.09.009
[17] Moreno-Sánchez M. Elective neck dissection in oral squamous cell carcinoma of the upper maxilla: necessary[J]. Plast Aesthetic Res, 2016,3(6):175.
doi: 10.20517/2347-9264.2016.18
[18] Philip J, James R. Maxillary squamous cell carcinoma: an 11-year retrospective study of one regional cancer centre[J]. Int J Oral Maxillofac Surg, 2014,43(10):1195-1198.
doi: 10.1016/j.ijom.2014.05.020
[19] Troeltzsch M, Knösel T, Woodlock T, et al. Are there clinical or pathological parameters of maxillary oral squamous cell carcinoma with an influence on the occurrence of neck node metastasis? an appraisal of 92 patients[J]. J Oral Maxillofac Surg, 2016,74(1):79-86.
doi: 10.1016/j.joms.2015.07.011
[20] Dalal AJ, McLennan AS. Cervical metastases from maxillary squamous cell carcinoma: retrospective analysis and review of the literature[J]. Br J Oral Maxillofac Surg, 2013,51(8):702-706.
doi: 10.1016/j.bjoms.2013.08.011
[21] Sagheb K, Sagheb K, Taylor KJ, et al. Cervical metastases of squamous cell carcinoma of the maxilla: a retrospective study of 25 years[J]. Clin Oral Investig, 2014,18(4):1221-1227.
doi: 10.1007/s00784-013-1070-8 pmid: 23934238
[22] Joosten MHMA, de Bree R, van Cann EM. Management of the clinically node negative neck in squamous cell carcinoma of the maxilla[J]. Oral Oncol, 2017,66:87-92.
doi: 10.1016/j.oraloncology.2016.12.027
[23] Eskander A, Givi B, Gullane PJ, et al. Outcome predictors in squamous cell carcinoma of the maxillary alveolus and hard palate[J]. Laryngoscope, 2013,123(10):2453-2458.
[24] Morris LG, Patel SG, Shah JP, et al. High rates of regional failure in squamous cell carcinoma of the hard palate and maxillary alveolus[J]. Head Neck, 2011,33(6):824-830.
doi: 10.1002/hed.v33.6
[25] Meng FY, Ko JY, Lou PJ, et al. The determining risk factors for treatment outcomes in patients with squamous cell carcinoma of the hard palate[J]. Ann Surg Oncol, 2012,19(6):2003-2010.
doi: 10.1245/s10434-011-2214-1
[26] Ogura I, Kurabayashi T, Sasaki T, et al. Maxillary bone invasion by gingival carcinoma as an indicator of cervical metastasis[J]. Dentomaxillofac Radiol, 2003,32(5):291-294.
doi: 10.1259/dmfr/25125369
[27] 周子夷. cN0上牙龈鳞癌颈部处理的临床分析[D]. 石家庄: 河北医科大学第四医院, 2018.
Zhou ZY. Clinical analysis of neck treatment of cN0 upper gingival squamous cell carcinoma[D]. Shijia-zhang: The Fourth Hospital of Hebei Medical Univer-sity, 2018.
[28] Lubek J, El-Hakim M, Salama AR, et al. Gingival carcinoma: retrospective analysis of 72 patients and indications for elective neck dissection[J]. Br J Oral Maxillofac Surg, 2011,49(3):182-185.
doi: 10.1016/j.bjoms.2010.04.005
[29] Morice A, Ostertag A, Sahli-Amor M, et al. Prognostic factors of gingival-alveolar squamous cell carcinoma of the maxilla[J]. Surg Oncol, 2016,25(3):263-268.
doi: 10.1016/j.suronc.2016.05.011 pmid: 27566032
[30] Slieker FJB, de Bree R, Van Cann EM. Predicting individualized mortality probabilities for patients wi-th squamous cell carcinoma of the maxilla: novel models with clinical and histopathological predictors[J]. Head Neck, 2019,41(10):3584-3593.
doi: 10.1002/hed.v41.10
[31] Lee KC, Chuang SK, Philipone EM, et al. Which clinicopathologic factors affect the prognosis of gingival squamous cell carcinoma: a population analysis of 4,345 cases[J]. J Oral Maxillofac Surg, 2019,77(5):986-993.
doi: 10.1016/j.joms.2019.01.007
[32] Wang TC, Hua CH, Lin CC, et al. Risk factors affect the survival outcome of hard palatal and maxillary alveolus squamous cell carcinoma: 10-year review in a tertiary referral center[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010,110(1):11-17.
doi: 10.1016/j.tripleo.2009.11.035
[33] Koshkareva Y, Liu JC, Lango M, et al. Cervical metastasis in squamous cell carcinoma of the hard palate and maxillary alveolus[J]. Ear Nose Throat J, 2016,95(10/11):E6-E11.
doi: 10.1177/014556131609510-1103
[34] Yang ZN, Deng RZ, Sun GW, et al. Cervical metastases from squamous cell carcinoma of hard palate and maxillary alveolus: a retrospective study of 10 years[J]. Head Neck, 2014,36(7):969-975.
doi: 10.1002/hed.v36.7
[35] Binahmed A, Nason RW, Hussain A, et al. Treatment outcomes in squamous cell carcinoma of the maxillary alveolus and palate: a population-based study[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008,105(6):750-754.
doi: 10.1016/j.tripleo.2007.09.001
[36] Os AD, Karakullukcu B, Leemans CR, et al. Management of the clinically N0 neck in squamous cell carcinoma of the maxillary alveolus and hard palate[J]. Head Neck, 2016,38(12):1794-1798.
doi: 10.1002/hed.v38.12
[1] 刘世一, 陈中, 张素欣. 程序性死亡受体/配体免疫治疗策略在人乳头瘤病毒阳性头颈部鳞状细胞癌中的研究进展[J]. 国际口腔医学杂志, 2024, 51(1): 21-27.
[2] 周金阔,张晋弘,史晓晶,刘广顺,姜磊,刘倩峰. 长链非编码RNA小核仁RNA宿主基因22调控微小RNA-27b-3p对口腔鳞状细胞癌细胞增殖、侵袭和迁移的影响[J]. 国际口腔医学杂志, 2024, 51(1): 52-59.
[3] 李立恒,王蕊,王晓明,张智轶,张璇,安峰,王芹,张凡. 环状RNA hsa_circ_0085576调控微小RNA-498/B细胞特异性莫洛尼鼠白血病病毒整合位点1轴对口腔鳞状细胞癌细胞迁移和侵袭的影响[J]. 国际口腔医学杂志, 2024, 51(1): 60-67.
[4] 吴佳敏,夏斌,杨禾丰,许彪. 癌相关成纤维细胞在口腔鳞状细胞癌微环境中作用的研究进展[J]. 国际口腔医学杂志, 2023, 50(6): 711-717.
[5] 柳江龙, 买买提吐逊·吐尔地. 超声造影在口腔鳞状细胞癌颈部转移性淋巴结诊断中的研究进展[J]. 国际口腔医学杂志, 2023, 50(5): 514-520.
[6] 李奕君, 徐子昂, 李一. 前哨淋巴结在头颈部鳞状细胞癌检测的应用进展[J]. 国际口腔医学杂志, 2023, 50(5): 521-527.
[7] 盛南宁,王珏,南欣荣. 性别决定基因盒9在口腔鳞状细胞癌作用机制和治疗中的研究进展[J]. 国际口腔医学杂志, 2023, 50(3): 314-320.
[8] 李潭,梁新华. 盘状蛋白结构域受体1在调控恶性肿瘤进展和治疗中的作用[J]. 国际口腔医学杂志, 2023, 50(2): 230-236.
[9] 李洪芳,陈中,张素欣. 免疫检查点抑制剂联合放射治疗在头颈部鳞状细胞癌治疗中的研究进展[J]. 国际口腔医学杂志, 2022, 49(5): 614-620.
[10] 赵卓平,辛鹏飞,高阳,张彩凤,张宽收,刘青梅. 光热治疗在口腔鳞状细胞癌治疗中的研究进展[J]. 国际口腔医学杂志, 2022, 49(4): 462-470.
[11] 江涵,神应强,陈谦明. 毒蕈碱受体通过Yes相关蛋白信号对口腔鳞状细胞癌生物学行为的实验研究[J]. 国际口腔医学杂志, 2022, 49(2): 138-143.
[12] 谢文婷,邢雅芹,崔洋洋,闫佳银,张淋坤. 不同鼻通气量硬腭上表面压强分布的有限元研究[J]. 国际口腔医学杂志, 2022, 49(1): 48-54.
[13] 蒋宇磊,夏斌,饶南荃,杨禾丰,许彪. 外泌体在口腔鳞状细胞癌恶性进展及诊疗应用的研究[J]. 国际口腔医学杂志, 2021, 48(6): 711-717.
[14] 刘嘉程,孟昭松,李宏捷,隋磊. 卵泡抑素在口腔颌面部发育中的作用及其治疗应用前景[J]. 国际口腔医学杂志, 2021, 48(5): 556-562.
[15] 王岳,季一鸣,王晓毅,张凌楠,孙乐刚. 人乳头状瘤病毒16相关口咽鳞状细胞癌独特生物学行为及治疗的研究现状[J]. 国际口腔医学杂志, 2021, 48(4): 450-458.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 王昆润. 二甲亚砜和双氯芬酸并用治疗根尖周炎[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 汤庆奋,王学侠. 17β-雌二醇对人类阴道和口腔颊粘膜的渗透性[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 潘劲松. 颈总动脉指压和颈内动脉球囊阻断试验在大脑血液动力学中的不同影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 王昆润. 后牙冠根斜形牙折的治疗[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 杨锦波. 嵌合体防龋疫苗的研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 王昆润. 下颔骨成形术用网状钛板固定植骨块[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 汪月月,郭莉莉. 口腔机能与老化—痴呆危险因素流行病学研究[J]. 国际口腔医学杂志, 1999, 26(04): .
[8] 丁刚. 应用硬组织代用品种植体行丰颏术[J]. 国际口腔医学杂志, 1999, 26(04): .
[9] 田磊. 局部应用脂多糖后结合上皮反应性增生的变化[J]. 国际口腔医学杂志, 1999, 26(04): .
[10] 戴青. 口腔念珠菌病的新分类[J]. 国际口腔医学杂志, 1999, 26(04): .