口腔癌手術治療的結果分析

Results and Experience of Surgery for Oral Cavity Cancer

戴世光(Shyh-Kuan Tai) ； 張學逸(Shyue-Yih Chang)

《中華民國耳鼻喉科醫學雜誌》 37卷5期 (2002/08) Pp. 342-346

https://doi.org/10.6286/2002.37.5.342

摘要

背景：口腔癌是台灣地區最常見的頭頸部惡性腫瘤。早期診斷及徹底手術切除是治療口腔癌的最重要步驟，耳鼻喉科醫師是診斷與治療口腔癌的主要成員，我們回顧過去91例口腔癌治療的長期經驗，以作為未來治療與改進的依據。
方法：回溯分析自1984年10月至1995年4月，由資深作者主刀的初發口腔鱗狀上皮癌病患共91例，男女比為8.1比1，平均年齡51.0歲，平均追蹤時間為50.2月。腫瘤分布以舌癌58例為最多，臨床頸部轉移的出現有22例（24.2%），晚期病例（stage III-IV）佔41例（45.1%）。原發腫瘤的治療為徹底手術切除，頸部處置包括治療性頸部廓清術（therapeutic neck dissection）、選擇性頸部廓清術（elective neck dissection）、放射線治療或密切追蹤。
結果：5年局部控制率為85.1%，局部復發的治療仍以手術為主，救援治療成功率為61.5%。頸部轉移的發生率隨原發腫瘤分期的上升而增加，5年頸部控制率為74.6%，救援治療成功率為68.4%，頸部處置採密切追蹤者有35.5%產生頸部復發，5年遠處轉移發生率為11.3%，晚期病例高達18.5%。5年第二原發腫瘤發生率為21.8%，其中84.6%仍出現於口腔。5年無病存活率（disease freesurvival）為69.3%，其中stage I-II為86.6%，stage III-IV只有45.8%。
結論：口腔癌早晚期治療結果的差距很大，積極的選擇性頸部廓清術對於臨床NO的頸部，是值得提倡的治療方式，且追蹤時應持續注意是否有口腔之第二原發腫瘤及肺部遠處轉移的發生。

關鍵字

口腔癌 ； 治療性頸部廓清術 ； 選擇性頸部廓清術

並列摘要

BACKGROUND: Oral cavity cancer is the most common head and neck cancer in Taiwan. Long-term experience of surgery for oral cavity cancer was presented for further efforts upon oral cavity cancer treatment.
METHODS: Retrospective review of 91 consecutive patients with oral cavity cancer oper-ated on with curative intent by the sonior author between Oct 1984 and Apr 1995 was done. The average follow-up time was 50.2 months. Tongue cancer was the most common primary in the series. Clinically positive neck disease was found in 22 patients. Forty-one cases were stage III-IV. Radical excision was done for oral cavity primary and neck treat-ment mainly comprised therapeutic neck dissection, elective neck dissection, radiother-apy or watchful waiting policy.
RESULTS: The overall local control rate was 85.1%. Surgery remained the main salvage treatment. The rate of neck metastasis increased in accordance with tumor T stage. The overall neck control rate was 74.6%. Neck metastasis occurred in 35.5% of cases undergo-ing watchful waiting policy. Overall distant metastasis rate was 11.3%, but 18.5% for stage III-IV cases. A second primary malignancy occurred in 21.8% of cases, with 84.6% of the new primary also arising in oral cavity. The 5-year disease-free survival was esti-mated to be 69.3%, based on 86.6% and 45.8% for stage I-II and stage III-IV cases respect-tively.
CONCLUSIONS: Early diagnosis and radical excision are critically important manage-ment steps for oral cavity cancer treatment. Aggressive neck dissection for clinically NO neck seems worthwhile based on our series. The occurrence of a second primary cancer in oral cavity and the possibility of lung metastasis should be carefully evaluated in the follow-up visits.

並列關鍵字

oral cavity cancer ； therapeutic neck dissection ； elective neck dissection