CN_0舌鳞癌颈部淋巴结隐匿性微转移与预后的研究
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摘要
目的:研究CN_0舌鳞癌病例中颈淋巴结隐匿性转移(PN_1)、隐匿性微转移(简称微转移,PN_(m+))病例与确无淋巴结转移(PN_0)的病例三者间预后的关系,以确定PN_(m+)病例是否如PN_1病例一样需在术后补充放射治疗。方法:(1)搜集福建省肿瘤医院自1993年8月到2002年11月间的CNO舌鳞癌病例共54例。(2)对PN_0病例分别用免疫组织化学染色(IHC)和原位杂交(ISH)方法结合半连续切片查找PN_(m+)病例。(3)分别统计PN_1、PN_(m+)、以及PN_0组的死亡率及生存期。(4)对采集的数据用SPSS10.0软件进行统计学处理。结果:至研究结束时止,所有复发病例均已死亡,PN_1组与PN_(m+)组间的死亡率没有显著性差异;在PN_1组与PN_0组间以及PN_(m+)组与PN_0组间则存在显著性差异。PN_1组与PN_(m+)组的生存期没有显著性差异;在PN_1组与PN_0组以及PN_(m+)组与PN_0组间则存在显著性差异。结论:PN_1组与PN_(m+)组病例的预后相似,均较PN_0组例预后差,从而证明了PN_(m+)病例和PN_1病例一样,需要在手术后进行辅助放疗。
Purpose: To investigate the relationship of the prognosis of the patients suffering tongue squamous cell carcinoma (SCC) with cervical lymph node occult metastasis(PN_1), micro metastasis (PN_(m+)), none metastasis (PN_0), in order to definite whether the patients with PN_(m+) need postoperative radiotherapy as PN_1 .
Methods: (1) Collect 54 cases of CN_0 tongue SCC treated in FuJian tumour hospital, ranged from Aug. 1993 to Dec. 2002. (2) All the paraffin block of PN_0 was restudied by immunohistochemistry stain (IHC) and in situ hybridization (ISH) with semi step section. (3) To add up the rate of death and the survival time. (4) All the data were analysesed with SPSS 10.0.
Results: To the end of this study, all the patients with recurrence were dead. There is no significance in the ratio of death between the group PN_1 and PN_(m+), and a significance between groupPN_1 and PN_0 as between the group PN m+1 and PN_0. There is no significance in survival time between group PN_1 and PN_(m+),and a significance between the group PN_1 and PN_0 as between the group PN_(m+) and PN_0.
Conclusions: The prognosis of the patients with PN_(m+).is equivalent with the patients with PN_1 . And they are poorer than the patients with PN_0. The patients with PN_(m+) need postoperative adjuvant radiotherapy as the patients with PN_1 .
Purpose: To investigate the relationship of the prognosis of the patients suffering tongue squamous cell carcinoma (SCC) with cervical lymph node occult metastasis(PN_1), micro metastasis (PN_(m+)), none metastasis (PN_0), in order to definite whether the patients with PN_(m+) need postoperative radiotherapy as PN_1 .
Methods: (1) Collect 54 cases of CN_0 tongue SCC treated in FuJian tumour hospital, ranged from Aug. 1993 to Dec. 2002. (2) All the paraffin block of PN_0 was restudied by immunohistochemistry stain (IHC) and in situ hybridization (ISH) with semi step section. (3) To add up the rate of death and the survival time. (4) All the data were analysesed with SPSS 10.0.
Results: To the end of this study, all the patients with recurrence were dead. There is no significance in the ratio of death between the group PN_1 and PN_(m+), and a significance between groupPN_1 and PN_0 as between the group PN m+1 and PN_0. There is no significance in survival time between group PN_1 and PN_(m+),and a significance between the group PN_1 and PN_0 as between the group PN_(m+) and PN_0.
Conclusions: The prognosis of the patients with PN_(m+).is equivalent with the patients with PN_1 . And they are poorer than the patients with PN_0. The patients with PN_(m+) need postoperative adjuvant radiotherapy as the patients with PN_1 .
引文
1 Haas I, Hauser U, Ganzer U, The dilemma of follow-up in head and neck cancer patients. Eur Arch Oto-rhin0larygol, 2001 258(4): 177.
2 杨湛,普苹,温玉明等,口腔鳞癌浸润方式与颈淋巴结转移关系的组织学研究,华西口腔医学杂志,2005, 23(1): 49-52
3 赵宏伟,李龙江,谢文扬,口腔鳞癌淋巴结微转移灶检测对分歧和预后的影响,实用口腔医学,2004,20(3):316-318
4 Ferlito A, Shaha A R, Rinaldo A. The incidence of lymph node micrometastases in patients pathologically stage N0 in cancer 0f 0ral cavity and oropharynx. Oral Oncol, 2002,38:3-5
5 Woolgar JA. Micrometastasis in oral/oropharyngeal squamous cell carcinoma:incidence, histopathological features and clinical implications. Br J Oral Maxillofac Surg 1999,37(3):181
6 冯正虎,张文峰,赵怡芳,舌癌浸润方式与淋巴结包膜外侵犯的关系及临床意义,中国颅颌面外科,2003,2:45
7 初培国, 细胞角蛋白染色在肿瘤诊断中的应用. 中华病理学杂志, 2004,33(3): 273-276
8 邹浩,张文峰,陆彤彤等,舌癌VEGF-C表达与颈淋巴结转移的关系及其临床意义,武汉大学学报(医学版),2005,26(1):80-92
9 李伟忠,丁彦青,赵彤等,细胞角蛋白在口腔鳞癌颈淋巴结中的表达及意义,实用口腔医学杂志,2006,22(6):856-858
10 Ross G L, Souta D S, MacDonald D G, Improved staging of cervical metastases in clinically node negative patients with head and neck squamous cell carcinoma. Ann Surg Oncol, 2004,11: 213-218
11 徐世影,杨蓓蓓,头颈部鳞状细胞癌颈部淋巴结微转移灶的研究进展(综述),临床耳鼻咽喉科杂志,2006,20(8):378-380
12 林灼锋,李校坤,吴帆,实时定量聚合酶链反应的研究及应用(综述),暨南大学学报(自然科学版),2002, 23(5): 116-122.
13 Shores C G, Yin X, Funkhouser W, et al. Clinical evaluation of a newmolecular method for detection of micromeatstases in head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg, 2004,130:937-942.
14 Hamakawa H, Fukizumi M, Bao Y, et al. Keratin mRNA for detecting micromatastasis in cervical lymphonodes of oral cancer. Cancer Lett, 2000,160:115-123.
15 陈伟良,曾曙光,李海刚等,舌鳞癌组织iNOSmRNA表达及其意义,癌症,2004,21(3):314-318.
16 李晓明, 路秀英, 邸斌, X染色体灭活方式检测在诊断头颈鳞状细胞癌颈淋巴微转移中的作用, 中华耳鼻咽喉头颈外科杂志, 2005,40(11): 862-865.
17 杨宏宇,黄晓斌,李树春等 口腔鳞癌颈淋巴结转移的检测及临床意义,中国口腔颌面外科杂志, 2004. 2(2): 104-106
18 Akiko Onishi, Koh-Ichi Nakashiro, Mariko Mihara, et al., Basic and clinical studies on quantitative analysis of lymph node micrometastasis in oral cancer. Oncology Rrport, 2004,11: 33-39.
19 Ranierl JM, Wanger JD, Azuaje R, Davidson D, et al., Prognostic importants of lymph node tumor burden in melanoma patients staged by sentinel node biopsy, Ann Surg Oncol, 2002. 9(10): 975-81.
20 钟来平,张志愿,胡永杰等,口腔鳞癌组织 CK19 蛋白质与 mRNA 水平的关系及其临床意义,中国口腔颌面外科杂志,2007,5(3):170-175
21 冯玉梅,李树玲,李希等,无假基因干扰的CK-19RT-PCR方法检测乳腺癌外周血微转移,中国肿瘤临床,2003, 30(6): 393-400
22 吕晓智,陈万涛,张陈平 口腔癌与正常黏膜中细胞角蛋白基因13的表达. 上海口腔医学, 2005. 14(4): 378-381.
23 谢明,周建华,文继舫等,乳腺癌的前哨淋巴结 CK19mRNA 和蛋白的表达,中国现代医学杂志,2007,17(4):426-427
24 Hotckiss RS, Tensley KW, Swanson PE, et al. Depletion of dendritic cell, but not macrophages, in patients with sepsis. [J] Immunol, 2002, 168:22493-25000.
1. 何龙,王继群, 头颈部肿瘤隐匿性淋巴结转移研究进展. 国外医学肿瘤分册, 2004. 31(12): 28-30.
2. 林灼锋,李校坤,吴帆,时时定量聚合酶链反应的研究及应用(综述),暨南大学学报(自然科学版),2002, 23(5): 116-122.
3. 陈伟良,曾曙光,李海刚等,舌鳞癌组织iNOSmRNA表达及其意义,癌症,2004,21(3):314-318.
4. 李晓明, 路秀英, 邸斌, X染色体灭活方式检测在诊断头颈鳞状细胞癌颈淋巴微转移中的作用, 中华耳鼻咽喉头颈外科杂志, 2005,40(11): 862-865.
5. 杨宏宇,黄晓斌,李树春等 口腔鳞癌颈淋巴结转移的检测及临床意义,中国口腔颌面外科杂志, 2004. 2(2): 104-106.
6. 初培国, 细胞角蛋白染色在肿瘤诊断中的应用. 中华病理学杂志, 2004,33(3): 273-276
7. 聂敏海,钟利,曾光明等,细胞角蛋白CK19在口腔粘膜癌变过程中的变化. 中华口腔医学杂志,2002, 37(3): 187-190.
8. Ranierl JM, Wanger JD, Azuaje R, Davidson D, et al., Prognostic importants of lymph node tumor burden in melanoma patients staged by sentinel node biopsy, Ann Surg Oncol, 2002. 9(10): 975-81.
9. 冯玉梅,李树玲,李希等,无假基因干扰的CK-19RT-PCR方法检测乳腺癌外周血微转移,中国肿瘤临床,2003, 30(6): 393-400
10. 吕晓智,陈万涛,张陈平 口腔癌与正常黏膜中细胞角蛋白基因13的表达. 上海口腔医学, 2005. 14(4): 378-381.
11. 赵洪伟,李龙江,谢文扬,口腔鳞癌淋巴结微转移对分期和预后的影响. 实用口腔医学杂志,2004,20(3): 316-318.
12. 邢光明,路晴,侯晓薇等,乳腺癌微转移的CK19和CD44表达研究,中华普通外科杂志,2003, 18(8): 491-493.
13. 邹浩, 张文峰, 路彤彤等,舌癌VEGF2C表达与颈淋巴结转移的关系及其临床意义. 武汉大学学报(医学版), 2005, 26(1): 81-82.
14. AKIKO ONISHI1, KOH-ICHI NAKASHIRO1, MARIKO MIHARA1, et al., Basic and clinical studies on quantitative analysis of lymph node micrometastasis in oral cancer. ONCOLOGY REPORTS, 2004,11: 33-39.
15. Shuichi Kawashiri, Shigehiro Kumagai, Kiyoshi Kojima, et al., Reproduction of occult metastasis of head and neck cancer in nude mice. Clinical and Experimental Metastasis, 1999.17(4): 277-282.
16. Kocaturk S, Yilmazer D, Onal B, et al, Do micrometastasis detected with cytokeratin immunoperoxidase reactivity affect the treatment approach to neck in supraglottic cancers?. Otolaryngol Head Neck Surg. 2003. 128(3): 407-411.
17. Komukai S, Nishimaki T, Watanabe H, et al., Significance of immunohistochemical nodal micrometastases as a prognostic indicator in potentially curable oesophageal carcinoma. Br J Surg, 2000, 89 (2): 213-219.
18. 朱李军,丁学强,陈宇等,舌癌阴性淋巴结的微转移与临床病理及预后的相关分析,中国口腔颌面外科杂志,2006,4(5): 341-344.
19. Hamakawa H, Takemura K, Sumida T, Kayahara H, Tanioka H, Sogawa K. Histological study on pN upgrading of oral cancer. Virchows Arch, 2000;437:116–121.
20. Andersen PE, Cambronero E, Shaha AR, Shah JP. The extent of neck disease after regional failure during observation of the N0 neck. Am J Surg 1996;172:689–691.
21. 孙明磊,温玉明,王昌美等,临床舌鳞癌N0患者的颈部处理,实用口腔医学杂志,2003, 19(4): 349-351.
22. 吴正华,黄欣,康非吾等,颊粘膜鳞癌cN0患者的颈部处理,华西口腔医学杂志,2003, 21(3): 194-196.
23. Yutaka Yamazaki, Itsuo Chiba, Atsuko Hirai, et al., Clinical value of genetically diagnosed lymph node micrometastasis for patients with oral squamous cell carcinoma, Head & Neck, 2005, 27(8): 676-681.
2 杨湛,普苹,温玉明等,口腔鳞癌浸润方式与颈淋巴结转移关系的组织学研究,华西口腔医学杂志,2005, 23(1): 49-52
3 赵宏伟,李龙江,谢文扬,口腔鳞癌淋巴结微转移灶检测对分歧和预后的影响,实用口腔医学,2004,20(3):316-318
4 Ferlito A, Shaha A R, Rinaldo A. The incidence of lymph node micrometastases in patients pathologically stage N0 in cancer 0f 0ral cavity and oropharynx. Oral Oncol, 2002,38:3-5
5 Woolgar JA. Micrometastasis in oral/oropharyngeal squamous cell carcinoma:incidence, histopathological features and clinical implications. Br J Oral Maxillofac Surg 1999,37(3):181
6 冯正虎,张文峰,赵怡芳,舌癌浸润方式与淋巴结包膜外侵犯的关系及临床意义,中国颅颌面外科,2003,2:45
7 初培国, 细胞角蛋白染色在肿瘤诊断中的应用. 中华病理学杂志, 2004,33(3): 273-276
8 邹浩,张文峰,陆彤彤等,舌癌VEGF-C表达与颈淋巴结转移的关系及其临床意义,武汉大学学报(医学版),2005,26(1):80-92
9 李伟忠,丁彦青,赵彤等,细胞角蛋白在口腔鳞癌颈淋巴结中的表达及意义,实用口腔医学杂志,2006,22(6):856-858
10 Ross G L, Souta D S, MacDonald D G, Improved staging of cervical metastases in clinically node negative patients with head and neck squamous cell carcinoma. Ann Surg Oncol, 2004,11: 213-218
11 徐世影,杨蓓蓓,头颈部鳞状细胞癌颈部淋巴结微转移灶的研究进展(综述),临床耳鼻咽喉科杂志,2006,20(8):378-380
12 林灼锋,李校坤,吴帆,实时定量聚合酶链反应的研究及应用(综述),暨南大学学报(自然科学版),2002, 23(5): 116-122.
13 Shores C G, Yin X, Funkhouser W, et al. Clinical evaluation of a newmolecular method for detection of micromeatstases in head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg, 2004,130:937-942.
14 Hamakawa H, Fukizumi M, Bao Y, et al. Keratin mRNA for detecting micromatastasis in cervical lymphonodes of oral cancer. Cancer Lett, 2000,160:115-123.
15 陈伟良,曾曙光,李海刚等,舌鳞癌组织iNOSmRNA表达及其意义,癌症,2004,21(3):314-318.
16 李晓明, 路秀英, 邸斌, X染色体灭活方式检测在诊断头颈鳞状细胞癌颈淋巴微转移中的作用, 中华耳鼻咽喉头颈外科杂志, 2005,40(11): 862-865.
17 杨宏宇,黄晓斌,李树春等 口腔鳞癌颈淋巴结转移的检测及临床意义,中国口腔颌面外科杂志, 2004. 2(2): 104-106
18 Akiko Onishi, Koh-Ichi Nakashiro, Mariko Mihara, et al., Basic and clinical studies on quantitative analysis of lymph node micrometastasis in oral cancer. Oncology Rrport, 2004,11: 33-39.
19 Ranierl JM, Wanger JD, Azuaje R, Davidson D, et al., Prognostic importants of lymph node tumor burden in melanoma patients staged by sentinel node biopsy, Ann Surg Oncol, 2002. 9(10): 975-81.
20 钟来平,张志愿,胡永杰等,口腔鳞癌组织 CK19 蛋白质与 mRNA 水平的关系及其临床意义,中国口腔颌面外科杂志,2007,5(3):170-175
21 冯玉梅,李树玲,李希等,无假基因干扰的CK-19RT-PCR方法检测乳腺癌外周血微转移,中国肿瘤临床,2003, 30(6): 393-400
22 吕晓智,陈万涛,张陈平 口腔癌与正常黏膜中细胞角蛋白基因13的表达. 上海口腔医学, 2005. 14(4): 378-381.
23 谢明,周建华,文继舫等,乳腺癌的前哨淋巴结 CK19mRNA 和蛋白的表达,中国现代医学杂志,2007,17(4):426-427
24 Hotckiss RS, Tensley KW, Swanson PE, et al. Depletion of dendritic cell, but not macrophages, in patients with sepsis. [J] Immunol, 2002, 168:22493-25000.
1. 何龙,王继群, 头颈部肿瘤隐匿性淋巴结转移研究进展. 国外医学肿瘤分册, 2004. 31(12): 28-30.
2. 林灼锋,李校坤,吴帆,时时定量聚合酶链反应的研究及应用(综述),暨南大学学报(自然科学版),2002, 23(5): 116-122.
3. 陈伟良,曾曙光,李海刚等,舌鳞癌组织iNOSmRNA表达及其意义,癌症,2004,21(3):314-318.
4. 李晓明, 路秀英, 邸斌, X染色体灭活方式检测在诊断头颈鳞状细胞癌颈淋巴微转移中的作用, 中华耳鼻咽喉头颈外科杂志, 2005,40(11): 862-865.
5. 杨宏宇,黄晓斌,李树春等 口腔鳞癌颈淋巴结转移的检测及临床意义,中国口腔颌面外科杂志, 2004. 2(2): 104-106.
6. 初培国, 细胞角蛋白染色在肿瘤诊断中的应用. 中华病理学杂志, 2004,33(3): 273-276
7. 聂敏海,钟利,曾光明等,细胞角蛋白CK19在口腔粘膜癌变过程中的变化. 中华口腔医学杂志,2002, 37(3): 187-190.
8. Ranierl JM, Wanger JD, Azuaje R, Davidson D, et al., Prognostic importants of lymph node tumor burden in melanoma patients staged by sentinel node biopsy, Ann Surg Oncol, 2002. 9(10): 975-81.
9. 冯玉梅,李树玲,李希等,无假基因干扰的CK-19RT-PCR方法检测乳腺癌外周血微转移,中国肿瘤临床,2003, 30(6): 393-400
10. 吕晓智,陈万涛,张陈平 口腔癌与正常黏膜中细胞角蛋白基因13的表达. 上海口腔医学, 2005. 14(4): 378-381.
11. 赵洪伟,李龙江,谢文扬,口腔鳞癌淋巴结微转移对分期和预后的影响. 实用口腔医学杂志,2004,20(3): 316-318.
12. 邢光明,路晴,侯晓薇等,乳腺癌微转移的CK19和CD44表达研究,中华普通外科杂志,2003, 18(8): 491-493.
13. 邹浩, 张文峰, 路彤彤等,舌癌VEGF2C表达与颈淋巴结转移的关系及其临床意义. 武汉大学学报(医学版), 2005, 26(1): 81-82.
14. AKIKO ONISHI1, KOH-ICHI NAKASHIRO1, MARIKO MIHARA1, et al., Basic and clinical studies on quantitative analysis of lymph node micrometastasis in oral cancer. ONCOLOGY REPORTS, 2004,11: 33-39.
15. Shuichi Kawashiri, Shigehiro Kumagai, Kiyoshi Kojima, et al., Reproduction of occult metastasis of head and neck cancer in nude mice. Clinical and Experimental Metastasis, 1999.17(4): 277-282.
16. Kocaturk S, Yilmazer D, Onal B, et al, Do micrometastasis detected with cytokeratin immunoperoxidase reactivity affect the treatment approach to neck in supraglottic cancers?. Otolaryngol Head Neck Surg. 2003. 128(3): 407-411.
17. Komukai S, Nishimaki T, Watanabe H, et al., Significance of immunohistochemical nodal micrometastases as a prognostic indicator in potentially curable oesophageal carcinoma. Br J Surg, 2000, 89 (2): 213-219.
18. 朱李军,丁学强,陈宇等,舌癌阴性淋巴结的微转移与临床病理及预后的相关分析,中国口腔颌面外科杂志,2006,4(5): 341-344.
19. Hamakawa H, Takemura K, Sumida T, Kayahara H, Tanioka H, Sogawa K. Histological study on pN upgrading of oral cancer. Virchows Arch, 2000;437:116–121.
20. Andersen PE, Cambronero E, Shaha AR, Shah JP. The extent of neck disease after regional failure during observation of the N0 neck. Am J Surg 1996;172:689–691.
21. 孙明磊,温玉明,王昌美等,临床舌鳞癌N0患者的颈部处理,实用口腔医学杂志,2003, 19(4): 349-351.
22. 吴正华,黄欣,康非吾等,颊粘膜鳞癌cN0患者的颈部处理,华西口腔医学杂志,2003, 21(3): 194-196.
23. Yutaka Yamazaki, Itsuo Chiba, Atsuko Hirai, et al., Clinical value of genetically diagnosed lymph node micrometastasis for patients with oral squamous cell carcinoma, Head & Neck, 2005, 27(8): 676-681.