舌扁平上皮癌二次症例における救済手術の予後—一次症例との比較より
Reported rates of oral cancer recurrence range from 25 % to 48 %. Improving the treatment outcomes of these cases would lead to a better prognosis of oral cancer. The aim of this study was to evaluate prognostic factors and the outcomes after salvage surgery in patients with squamous cell carcinoma...
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| Published in | 日本口腔外科学会雑誌 Vol. 56; no. 10; pp. 561 - 567 |
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| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
社団法人 日本口腔外科学会
20.10.2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5163 2186-1579 |
| DOI | 10.5794/jjoms.56.561 |
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| Abstract | Reported rates of oral cancer recurrence range from 25 % to 48 %. Improving the treatment outcomes of these cases would lead to a better prognosis of oral cancer. The aim of this study was to evaluate prognostic factors and the outcomes after salvage surgery in patients with squamous cell carcinoma of the tongue. We analyzed 110 patients who underwent primary radical surgery (primary cases) and 77 previously treated patients who underwent salvage surgery (secondary cases) between March 1985 and March 2000. A 5-year survival curve was constructed using the Kaplan-Meier method. Statistical significance was evaluated with the logrank test. A Cox proportional-hazards regression analysis was used to identify prognostic factors. Recurrence rates in primary/secondary cases were 17.3 %/9.1 % for delayed neck metastasis, 10.0 %/15.6 %for local recurrences, 5.5 %/10.4 % for regional recurrences, and 3.6 %/2.6 % for locoregional recurrences.Overall 5-year survival rates were 78.9 % for primary cases and 67.5 % for secondary cases. Survival rates differed significantly between rN − (82.9 %) and rN + (54.8 %) secondary cases treated by salvage surgery. Significant prognostic factors on multivariate analysis were the extracapsular spread of cervical lymph node metastasis in both primary and secondary cases and the pN category in secondary cases. In conclusion, extracapsular spread was a significant predictor of survival. Salvage surgery cases with neck recurrence had poor outcomes. |
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| AbstractList | Reported rates of oral cancer recurrence range from 25 % to 48 %. Improving the treatment outcomes of these cases would lead to a better prognosis of oral cancer. The aim of this study was to evaluate prognostic factors and the outcomes after salvage surgery in patients with squamous cell carcinoma of the tongue. We analyzed 110 patients who underwent primary radical surgery (primary cases) and 77 previously treated patients who underwent salvage surgery (secondary cases) between March 1985 and March 2000. A 5-year survival curve was constructed using the Kaplan-Meier method. Statistical significance was evaluated with the logrank test. A Cox proportional-hazards regression analysis was used to identify prognostic factors. Recurrence rates in primary/secondary cases were 17.3 %/9.1 % for delayed neck metastasis, 10.0 %/15.6 %for local recurrences, 5.5 %/10.4 % for regional recurrences, and 3.6 %/2.6 % for locoregional recurrences.Overall 5-year survival rates were 78.9 % for primary cases and 67.5 % for secondary cases. Survival rates differed significantly between rN − (82.9 %) and rN + (54.8 %) secondary cases treated by salvage surgery. Significant prognostic factors on multivariate analysis were the extracapsular spread of cervical lymph node metastasis in both primary and secondary cases and the pN category in secondary cases. In conclusion, extracapsular spread was a significant predictor of survival. Salvage surgery cases with neck recurrence had poor outcomes. |
| Author | 後藤, 満雄 長谷川, 泰久 |
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| Copyright | 2010 社団法人 日本口腔外科学会 |
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| References | 15) Goto, M., Hasegawa, Y., et al.: Prognostic significance of late cervical metastasis and distant failure in patients with stage I and II oral tongue cancers. Oral Oncol 41: 62-69 2005. 35) Ferlito, A., Shaha, A.R., et al.: Surgical management of recurrent tumor in the neck. Acta Otolaryngol 122: 121-126 2002. 5) Jemal, A., Clegg, L.X., et al.: Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer 101: 3-27 2004. 46) Mabanta, S.R., Mendenhall, W.M., et al.: Salvage treatment for neck recurrence after irradiation alone for head and neck squamous cell carcinoma with clinically positive neck nodes. Head Neck 21: 591-594 1999. 20) Spiro, R.H., Morgan, G.J., et al.: Supraomohyoid neck dissection. Am J Surg 172: 650-653 1996. 10) Forastiere, A., Koch, W., et al.: Head and neck cancer. N Engl J Med 345: 1890-1900 2001. 22) 長谷川泰久, 藤本保志, 他：進行舌癌手術例における再発と予後因子の検討. 頭頸部腫瘍 28: 489-495 2002. 47) Cherian, T., Sebastian, P., et al.: Evaluation of salvage surgery in heavily irradiated cancer of the buccal mucosa. Cancer 68: 295-299 1991. 3) Parkin, D.M., Bray, F., et al.: Global cancer statistics, 2002. CA Cancer J Clin 55: 74-108 2005. 7) Saunders, M.I. and Rojas, A.M.: Management of cancer of the head and neck − a cocktail with your PORT ? N Engl J Med 350: 1997-1999 2004. 19) Byers, R.M., Weber, R.S., et al.: Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck 19: 14-19 1997. 2) Parkin, D.M., Pisani, P., et al.: Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80: 827-841 1999. 24) Schwartz, G.J., Mehta, R.H., et al.: Salvage treatment for recurrent squamous cell carcinoma of the oral cavity. Head Neck 22: 34-41 2000. 18) Beeken, S.W., Krontiras, H., et al.: T1 and T2 squamous cell carcinoma of the oral tongue: prognostic factors and the role of elective lymph node dissec- tion. Head Neck 21: 124-130 1999. 31) Gilbert, H. and Kagan, A.R.: Recurrence patterns in squamous cell carcinoma of the oral cavity, pharynx, and larynx. J Surg Oncol 6: 357-380 1974. 43) Gujrathi, D., Kerr, P., et al.: Treatment outcome of squamous cell carcinoma of the oral tongue. J Otolaryngol 25: 145-149 1996. 30) Woolgar, J.A. and Scott, J.: Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. Head Neck 17: 463-472 1995. 41) Stell, P.M.: Time to recurrence of squamous cell carcinoma of the head and neck. Head Neck 13: 277-281 1991. 21) Shintani, S., Matsuura, H., et al.: The relationship of shape of tumor invasion to depth of invasion and cervical lymph node metastasis in squamous cell carcinoma of the tongue. Oncology 54: 463-467 1997. 6) Jemal, A., Siegel, R., et al.: Cancer statistics, 2009. CA Cancer J Clin 59: 225-249 2009. 29) Moore, C., Kuhns, J.G., et al.: Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg 121: 1410-1414 1986. 8) Vermorken, J.B., Remenar, E., et al.: Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357: 1695-1704 2007. 13) Mao, L., Hong, W.K., et al.: Focus on head and neck cancer. Cancer Cell 5: 311-316 2004. 23) Lacy, P.D., Spitznagel, E.L., Jr., et al.: Development of a new staging system for recurrent oral cavity and oropharyngeal squamous cell carcinoma. Cancer 86: 1387-1395 1999. 26) Fleming, I.D., Cooper, J.S., et al.: American Joint Committee on Cancer staging manual. 5th ed. ed. Philadelphia: JB Lippincott; 1997. 36) Kowalski, L.P.: Results of salvage treatment of the neck in patients with oral cancer. Arch Otolaryngol Head Neck Surg 128: 58-62 2002. 9) Haddad, R.I. and Shin, D.M.: Recent advances in head and neck cancer. N Engl J Med 359: 1143-1154 2008. 27) Sobin LH, W.C., eds. UICC TNM Classification of malignant tumors. 6th ed. ed. New York: John Wiley & Sons, Inc.; 2002. 17) Spiro, R.H., Huvos, A.G., et al.: Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg 152: 345-350 1986. 42) Agra, I.M., Carvalho, A.L., et al.: Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 28: 107-113 2006. 38) Huang, S.H., Hwang, D., et al.: Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a metaanalysis of reported studies. Cancer 115: 1489-1497 2009. 28) Shanmugaratnam, K.: Histological typing of tumours of the upper respiratory tract and ear. International Histological Classification of Tumours. 2nd edn ed. Berlin: Spring-Verlag; 1991. 33) Haddadin, K.J., Soutar, D.S., et al.: Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 21: 517-525 1999. 37) Pivot, X., Niyikiza, C., et al.: Clinical prognostic factors for patients with recurrent head and neck cancer: implications for randomized trials. Oncology 61: 197-204 2001. 4) Neville, B.W. and Day, T.A.: Oral cancer and precancerous lesions. CA Cancer J Clin 52: 195-215 2002. 16) Fukano, H., Matsuura, H., et al.: Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 19: 205-210 1997. 39) Davidson, J., Keane, T., et al.: Surgical salvage after radiotherapy for advanced laryngopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 123: 420- 424 1997. 25) Goodwin, W.J., Jr.: Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means ? Laryngoscope 110: 1-18 2000. 32) Gold, K.A., Lee, H.Y., et al.: Targeted therapies in squamous cell carcinoma of the head and neck. Cancer 115: 922-935 2009. 14) Shah, J.P.: Head and Neck surgery. 2nd edn ed. New York: Mosby-Wolfe; 1996. 12) Myers, J.N., Greenberg, J.S., et al.: Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 92: 3030-3036 2001. 44) Chhetri, D.K., Rawnsley, J.D., et al.: Carcinoma of the buccal mucosa. Otolaryngol Head Neck Surg 123: 566-571 2000. 45) Yuen, A.P., Wei, W.I., et al.: Local recurrence of carcinoma of the tongue after glossectomy: patient prognosis. Ear Nose Throat J 77: 181-184 1998. 40) Ord, R.A., Kolokythas, A., et al.: Surgical salvage for local and regional recurrence in oral cancer. J Oral Maxillofac Surg 64: 1409-1414 2006. 34) Ho, C.M., Lam, K.H., et al.: Occult lymph node metastasis in small oral tongue cancers. Head Neck 14: 359-363 1992. 1) Vokes, E.E., Weichselbaum, R.R., et al.: Head and neck cancer. N Engl J Med 328: 184-194 1993. 11) Silverman, S., Jr.: Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc 132 Suppl: 7S-11S 2001. |
| References_xml | – reference: 12) Myers, J.N., Greenberg, J.S., et al.: Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 92: 3030-3036 2001. – reference: 21) Shintani, S., Matsuura, H., et al.: The relationship of shape of tumor invasion to depth of invasion and cervical lymph node metastasis in squamous cell carcinoma of the tongue. Oncology 54: 463-467 1997. – reference: 14) Shah, J.P.: Head and Neck surgery. 2nd edn ed. New York: Mosby-Wolfe; 1996. – reference: 19) Byers, R.M., Weber, R.S., et al.: Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck 19: 14-19 1997. – reference: 26) Fleming, I.D., Cooper, J.S., et al.: American Joint Committee on Cancer staging manual. 5th ed. ed. Philadelphia: JB Lippincott; 1997. – reference: 46) Mabanta, S.R., Mendenhall, W.M., et al.: Salvage treatment for neck recurrence after irradiation alone for head and neck squamous cell carcinoma with clinically positive neck nodes. Head Neck 21: 591-594 1999. – reference: 10) Forastiere, A., Koch, W., et al.: Head and neck cancer. N Engl J Med 345: 1890-1900 2001. – reference: 23) Lacy, P.D., Spitznagel, E.L., Jr., et al.: Development of a new staging system for recurrent oral cavity and oropharyngeal squamous cell carcinoma. Cancer 86: 1387-1395 1999. – reference: 9) Haddad, R.I. and Shin, D.M.: Recent advances in head and neck cancer. N Engl J Med 359: 1143-1154 2008. – reference: 47) Cherian, T., Sebastian, P., et al.: Evaluation of salvage surgery in heavily irradiated cancer of the buccal mucosa. Cancer 68: 295-299 1991. – reference: 3) Parkin, D.M., Bray, F., et al.: Global cancer statistics, 2002. CA Cancer J Clin 55: 74-108 2005. – reference: 29) Moore, C., Kuhns, J.G., et al.: Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg 121: 1410-1414 1986. – reference: 11) Silverman, S., Jr.: Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc 132 Suppl: 7S-11S 2001. – reference: 40) Ord, R.A., Kolokythas, A., et al.: Surgical salvage for local and regional recurrence in oral cancer. J Oral Maxillofac Surg 64: 1409-1414 2006. – reference: 20) Spiro, R.H., Morgan, G.J., et al.: Supraomohyoid neck dissection. Am J Surg 172: 650-653 1996. – reference: 44) Chhetri, D.K., Rawnsley, J.D., et al.: Carcinoma of the buccal mucosa. Otolaryngol Head Neck Surg 123: 566-571 2000. – reference: 13) Mao, L., Hong, W.K., et al.: Focus on head and neck cancer. Cancer Cell 5: 311-316 2004. – reference: 27) Sobin LH, W.C., eds. UICC TNM Classification of malignant tumors. 6th ed. ed. New York: John Wiley & Sons, Inc.; 2002. – reference: 18) Beeken, S.W., Krontiras, H., et al.: T1 and T2 squamous cell carcinoma of the oral tongue: prognostic factors and the role of elective lymph node dissec- tion. Head Neck 21: 124-130 1999. – reference: 30) Woolgar, J.A. and Scott, J.: Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. Head Neck 17: 463-472 1995. – reference: 31) Gilbert, H. and Kagan, A.R.: Recurrence patterns in squamous cell carcinoma of the oral cavity, pharynx, and larynx. J Surg Oncol 6: 357-380 1974. – reference: 1) Vokes, E.E., Weichselbaum, R.R., et al.: Head and neck cancer. N Engl J Med 328: 184-194 1993. – reference: 34) Ho, C.M., Lam, K.H., et al.: Occult lymph node metastasis in small oral tongue cancers. Head Neck 14: 359-363 1992. – reference: 43) Gujrathi, D., Kerr, P., et al.: Treatment outcome of squamous cell carcinoma of the oral tongue. J Otolaryngol 25: 145-149 1996. – reference: 41) Stell, P.M.: Time to recurrence of squamous cell carcinoma of the head and neck. Head Neck 13: 277-281 1991. – reference: 7) Saunders, M.I. and Rojas, A.M.: Management of cancer of the head and neck − a cocktail with your PORT ? N Engl J Med 350: 1997-1999 2004. – reference: 4) Neville, B.W. and Day, T.A.: Oral cancer and precancerous lesions. CA Cancer J Clin 52: 195-215 2002. – reference: 45) Yuen, A.P., Wei, W.I., et al.: Local recurrence of carcinoma of the tongue after glossectomy: patient prognosis. Ear Nose Throat J 77: 181-184 1998. – reference: 36) Kowalski, L.P.: Results of salvage treatment of the neck in patients with oral cancer. Arch Otolaryngol Head Neck Surg 128: 58-62 2002. – reference: 28) Shanmugaratnam, K.: Histological typing of tumours of the upper respiratory tract and ear. International Histological Classification of Tumours. 2nd edn ed. Berlin: Spring-Verlag; 1991. – reference: 39) Davidson, J., Keane, T., et al.: Surgical salvage after radiotherapy for advanced laryngopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 123: 420- 424 1997. – reference: 15) Goto, M., Hasegawa, Y., et al.: Prognostic significance of late cervical metastasis and distant failure in patients with stage I and II oral tongue cancers. Oral Oncol 41: 62-69 2005. – reference: 22) 長谷川泰久, 藤本保志, 他：進行舌癌手術例における再発と予後因子の検討. 頭頸部腫瘍 28: 489-495 2002. – reference: 2) Parkin, D.M., Pisani, P., et al.: Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80: 827-841 1999. – reference: 8) Vermorken, J.B., Remenar, E., et al.: Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357: 1695-1704 2007. – reference: 37) Pivot, X., Niyikiza, C., et al.: Clinical prognostic factors for patients with recurrent head and neck cancer: implications for randomized trials. Oncology 61: 197-204 2001. – reference: 35) Ferlito, A., Shaha, A.R., et al.: Surgical management of recurrent tumor in the neck. Acta Otolaryngol 122: 121-126 2002. – reference: 16) Fukano, H., Matsuura, H., et al.: Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 19: 205-210 1997. – reference: 24) Schwartz, G.J., Mehta, R.H., et al.: Salvage treatment for recurrent squamous cell carcinoma of the oral cavity. Head Neck 22: 34-41 2000. – reference: 5) Jemal, A., Clegg, L.X., et al.: Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer 101: 3-27 2004. – reference: 6) Jemal, A., Siegel, R., et al.: Cancer statistics, 2009. CA Cancer J Clin 59: 225-249 2009. – reference: 17) Spiro, R.H., Huvos, A.G., et al.: Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg 152: 345-350 1986. – reference: 32) Gold, K.A., Lee, H.Y., et al.: Targeted therapies in squamous cell carcinoma of the head and neck. Cancer 115: 922-935 2009. – reference: 33) Haddadin, K.J., Soutar, D.S., et al.: Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 21: 517-525 1999. – reference: 42) Agra, I.M., Carvalho, A.L., et al.: Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 28: 107-113 2006. – reference: 25) Goodwin, W.J., Jr.: Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means ? Laryngoscope 110: 1-18 2000. – reference: 38) Huang, S.H., Hwang, D., et al.: Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a metaanalysis of reported studies. Cancer 115: 1489-1497 2009. |
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| Title | 舌扁平上皮癌二次症例における救済手術の予後—一次症例との比較より |
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