口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响

doi:10.19438/j.cjoms.2021.02.008

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (2): 138-145.doi: 10.19438/j.cjoms.2021.02.008

口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响

周凯^1,2, 李恒勇^1,2, 齐晓杰³, 葛胜优^1,2, 孔钰^1,2, 宋凯^1,2, 冯元勇^1,2, 侯峰³, 史海磊³, 蒋艳霞³, 尚伟^1,2

1.青岛大学附属医院口腔颌面外科,山东青岛 266003;
2.青岛大学口腔医学院,山东青岛 266003;
3.青岛大学附属医院病理科,山东青岛 266003

收稿日期:2020-07-27 修回日期:2020-10-24 出版日期:2021-03-20 发布日期:2021-05-11
通讯作者: 尚伟,E-mail：liweishang@126.com
作者简介:周凯（1992-）,男,在读硕士研究生,E-mail: zk19920916@outlook.com

Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation

ZHOU Kai^1,2, LI Heng-yong^1,2, QI Xiao-jie³, GE Sheng-you^1,2, KONG Yu^1,2, SONG Kai^1,2, FENG Yuan-yong^1,2, HOU Feng³, SHI Hai-lei³, JIANG Yan-xia³, SHANG Wei^1,2

1. Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Qingdao University. Qingdao 266003;
2. School of Stomatology, Qingdao University. Qingdao 266003;
3. Department of Pathology, Affiliated Hospital of Qingdao University. Qingdao 266003, Shandong Province, China

Received:2020-07-27 Revised:2020-10-24 Online:2021-03-20 Published:2021-05-11

摘要/Abstract

摘要： 目的分析比较美国癌症联合委员会（AJCC）第8版与第7版TNM分期系统在口腔癌临床治疗决策、预后分层以及提高预后评价准确性中的意义。方法收集2009年1月—2015年6月手术治疗的原发口腔鳞状细胞癌患者,分别应用第7版、第8版TNM分期系统对肿瘤进行分期,比较2种分期的变化情况。采用SPSS 26.0软件包,运用Kaplan-Meier法绘制生存曲线和Log-rank检验生存曲线间的差别情况,计算各分期系统的C指数及Akaike信息标准,比较2种分期模型预测精度、拟合数据的优良性。结果随访570例患者,中位随访年龄64岁,中位随访时间38个月。第8版分期系统使得146例（25.61%）患者原有肿瘤分期发生了改变。T分期、TNM分期的总体生存和疾病别生存模型分析,第8版的AIC值均显著小于第7版,C指数均显著大于第7版（P<0.05）。结论口腔癌AJCC第8版TNM分期增加了浸润深度和淋巴结结外扩展2个指标,2个指标使按原标准分期的许多患者的病理分期发生了改变。浸润深度为6.25 mm时,可以很好地预测淋巴结转移性病变,亦是预测总体生存和疾病别生存的最佳界值。新版分期系统对口腔癌患者,尤其是晚期患者的临床决策、预后评价更具有指导意义。

关键词: 口腔癌, 鳞状细胞癌, AJCC 第7版, AJCC第8版, TNM分期, 预后

Abstract: PURPOSE: To analyze and compare the significance of the American Joint Committee on Cancer (AJCC) eighth edition and seventh edition of TNM staging system in clinical treatment decision-making, prognosis stratification and improving the accuracy of prognosis evaluation of oral cancer. METHODS: A retrospective cohort study of patients with oral squamous cell carcinoma(OSCC) from 2009 to 2015 was performed, and AJCC seventh and eighth edition of staging systems was applied to all patients. Overall survival and disease-specific survival were analyzed by Kaplan-Meier analysis and Log-rank test with SPSS 26.0 software package. Concordance index and Akaike information criterion was used to calculate the system's prognostic accuracy. RESULTS: In total, 570 patients were followed up with a median follow-up age of 64 years. The median follow-up peroid was 38 months. The tumor stage of 146 (25.61%) patients was changed by depth of invasion and extranodal extension. Overall survival and disease-specific survival model analysis of T stage and TNM stage showed that the Akaike information criterion of AJCC eighth edition staging systems was significantly lower than the seventh edition and concordance index was significantly higher than the seventh edition(P<0.05). CONCLUSIONS: Depth of invasion and extranodal extension were added to the TNM staging of oral cancer in the AJCC eighth edition of staging systems. These two indices have changed the pathological stages of many patients according to the original standard staging. The results showed that when depth of invasion is 6.25 mm, it can well predict cervical lymph node metastasis, and is also the optimal cut-off for predicting overall survival and disease-specific survival. The new staging system has more guiding significance for clinical decision-making and prognosis evaluation of oral cancer patients, especially for advanced patients.

Key words: Oral cancer, Squamous cell carcinoma, AJCC seventh edition, AJCC eighth edition, TNM stage, Prognosis

中图分类号:

R739.8

周凯, 李恒勇, 齐晓杰, 葛胜优, 孔钰, 宋凯, 冯元勇, 侯峰, 史海磊, 蒋艳霞, 尚伟. 口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响[J]. 中国口腔颌面外科杂志, 2021, 19(2): 138-145.

ZHOU Kai, LI Heng-yong, QI Xiao-jie, GE Sheng-you, KONG Yu, SONG Kai, FENG Yuan-yong, HOU Feng, SHI Hai-lei, JIANG Yan-xia, SHANG Wei. Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation[J]. China J Oral Maxillofac Surg, 2021, 19(2): 138-145.

参考文献

[1] 中华口腔医学会口腔颌面外科专业委员会肿瘤学组. 口腔颌面部恶性肿瘤治疗指南[J]. 中国口腔颌面外科杂志, 2010, 8(2): 98-106.
[2] 中华口腔医学会口腔病理学专业委员会. 口腔癌及口咽癌病理诊断规范[J]. 中华口腔医学杂志, 2020, 55(3): 145-152.
[3] Head and Neck Cancer Study Group (HNCSG), Monden N, Asakage T, et al. A review of head and neck cancer staging system in the TNM classification of malignant tumors (eighth edition)[J]. Jpn J Clin Oncol, 2019, 49(7): 589-595.
[4] Amin MB, Edge SB, Greene FL, et al.AJCC Cancer staging manual[M]. 8th Ed. New York: Springer, 2017.
[5] Union for International Cancer Control UICC 8th Edition Errata-25 of May2018[OL]. https://www.uicc.org/sites/main/files/atoms/files/UICC%208th%20Edition%20Errata_25May2018%20final.pdf.
[6] AJCC. AJCC Cancer Staging Form Supplement-Last updated 05 June2018[OL]. https://cancerstaging.org/references/tools/deskrefe rences/Documents/AJCC%20Cancer%20Staging%20Form%20 Supplement.pdf.
[7] Lydiatt WM, Patel SG, Osullivan B, et al.Head and neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual[J]. CA Cancer J Clin, 2017, 67(2): 122-137.
[8] 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.
[9] Pollaers K, Hinton-Bayre A, Friedland PL, et al.AJCC 8th Edition oral cavity squamous cell carcinoma staging - Is it an improvement on the AJCC 7th Edition[J]. Oral Oncol, 2018, 82(1): 23-28.
[10] 尚伟, 李薇, 郑家伟. 美国头颈癌患者生存资料分析[J]. 中国口腔颌面外科杂志, 2005, 3(1): 69-75.
[11] Cramer JD, Reddy A, Ferris RL, et al.Comparison of the seventh and eighth edition american joint committee on cancer oral cavity staging systems[J]. Laryngoscope, 2018, 128(10): 2351-2360.
[12] Singhavi HR, Chakrabarti S, Singh A, et al.Comparison of the seventh and eighth editions American Joint Committee Cancer classification system in oral cavity squamous cell cancers[J]. Int J Cancer, 2020,146(12): 3379-3384.
[13] Kheur SM, Routray S.Comment on "Tumour infiltration depth P4 mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma" by Melchers et al., Oral Oncol 2012; 48(4): 337-42[J]. Oral Oncol, 2012,48(6): e20-e21.
[14] 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.
[15] Shim SJ, Cha J, Koom WS, et al.Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy[J]. Radiat Oncol, 2010, 5(1): 43-50.
[16] Murthy SP, Thankappan K, Jayasankaran SC, et al."Deep extrinsic muscle involvement" is a fallacy in the American Joint Committee on Cancer's Seventh Edition of Tumor Staging of Oral Cavity Cancers[J]. J Oral Maxillofac Surg, 2018, 76(1): 206-212.
[17] Ebrahimi A, Gil Z, Amit M, et al.Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study[J]. JAMA Otolaryngol Head Neck Surg, 2014, 140(12): 1138-1148.
[18] Masood MM, Farquhar DR, Vanleer JP, et al.Depth of invasion on pathological outcomes in clinical low-stage oral tongue cancer patients[J]. Oral Dis, 2018, 24(7): 1198-1203.
[19] Kane SV, Gupta M, Kakade AC, et al.Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity[J]. Eur J Surg Oncol, 2006, 32(7): 795-803.
[20] Melchers LJ, Schuuring E, van Dijk BAC, et al. Tumour infiltration depth ≥ 4 mm is an indication for an elective neck dissection in pT1cN0 oral squamous cell carcinoma[J]. Oral Oncol, 2012, 48(4): 337-342.
[21] 李明, 南欣荣, 闫星泉. 舌鳞状细胞癌浸润深度评估方法的研究进展[J]. 中华口腔医学杂志, 2019, 54(10): 712-716.
[22] Arya S, Rane P, Deshmukh A.Oral cavity squamous cell carcinoma: Role of pretreatment imaging and its influence on management[J]. Clin Radiol, 2014, 69(9): 916-930.
[23] 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): 61-65.
[24] Kano S, Sakashita T, Tsushima N, et al.Validation of the 8th edition of the AJCC/UICC TNM staging system for tongue squamous cell carcinoma[J]. Int J Clin Oncol, 2018, 23(5): 844-850.
[25] Lubek JE, Magliocca KR.Evaluation of the bone margin in oral squamous cell carcinoma[J]. Oral Maxillofac Surg Clin North Am, 2017, 29(3): 281-292.
[26] Goerres GW, Schmid DT, Schuknecht B, et al.Bone invasion in patients with oral cavity cancer: comparison of conventional CT with PET/CT and SPECT/CT[J]. Radiology, 2005, 237(1): 281-287.
[27] Nulent TJWK, Noorlag R, Van Cann EM, et al.Intraoral ultrasonography to measure tumor thickness of oral cancer: a systematic review and meta-analysis[J]. Oral Oncol, 2018, 77: 29-36.

口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响

Effect of depth of invasion of oral squamous cell carcinoma on improving TNM staging and prognostic evaluation

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韩林孜, 周建华, 赵谦, 董磊, 陈正岗, 邱建忠, 袁荣涛. 肿瘤相关成纤维细胞对头颈部鳞状细胞癌肿瘤浸润免疫细胞的调控作用及机制探讨[J]. 中国口腔颌面外科杂志, 2023, 21(2): 119-124.
[2]	热孜万姑丽·亚森, 买热拍提·买明, 李晨曦, 龚忠诚. 牙龈卟啉单胞菌促进口腔鳞状细胞癌进展的作用及机制研究进展[J]. 中国口腔颌面外科杂志, 2023, 21(2): 186-190.
[3]	兰嵘, 阮敏, 韩楠男, 王凤. 左下种植修复后发生植体周围鳞状细胞癌1例报告[J]. 中国口腔颌面外科杂志, 2023, 21(2): 203-205.
[4]	陈伟良. 延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损[J]. 中国口腔颌面外科杂志, 2023, 21(1): 1-10.
[5]	苏姿尚, 崔文丽, 张梦云, 姚志涛. 口腔鳞状细胞癌患者颈部淋巴结特征与预后的关系[J]. 中国口腔颌面外科杂志, 2023, 21(1): 41-48.
[6]	李雪儿, 王正业, 买买提吐逊·吐尔地. 基于影像组学鉴定头颈部鳞状细胞癌患者HPV状态：诊断性meta分析[J]. 中国口腔颌面外科杂志, 2023, 21(1): 69-74.
[7]	周瑜, 翁海燕, 司呈云, 段贤捷, 安星妃, 章礼玉. 第8版TNM分期修订版对早期口腔黏膜鳞癌患者预后及危险分层作用的临床研究[J]. 中国口腔颌面外科杂志, 2022, 20(6): 571-576.
[8]	杨慧丽, 王宇帆, 王锋, 沈月洪, 杨宏宇. NLRP1在头颈部鳞癌中的表达及预后意义[J]. 中国口腔颌面外科杂志, 2022, 20(5): 429-436.
[9]	吴梓谦, 殷玉兰, 杨文玉, 张贞, 侯黎莉, 王磊. 口腔癌患者术后舌神经功能障碍与生活质量的关系评价[J]. 中国口腔颌面外科杂志, 2022, 20(5): 449-454.
[10]	樊文慧, 劳峥, 石慧烽, 毕帆, 涂文勇, 胡海生. 3D打印可分离式口腔支架在口腔癌放疗中的摆位准确性研究[J]. 中国口腔颌面外科杂志, 2022, 20(5): 466-470.
[11]	许刚, 宋其义, 蒋卫东, 刘景秀. 水通道蛋白3在口腔鳞癌中的表达及临床意义[J]. 中国口腔颌面外科杂志, 2022, 20(5): 478-482.
[12]	周艳艳, 刘丽, 金武龙. 左侧面部巨大基底细胞样鳞状细胞癌1例报告[J]. 中国口腔颌面外科杂志, 2022, 20(5): 517-520.
[13]	赵小妹, 夏荣辉, 钟来平, 朱东旺, 张志愿. Nrf2对口腔鳞癌患者TPF诱导化疗效果的影响[J]. 中国口腔颌面外科杂志, 2022, 20(4): 366-370.
[14]	李恒勇, 杨宋, 周凯, 孔钰, 李洁莹, 李贵忠, 葛胜优, 杨小琛, 冯元勇, 宋凯, 尚伟. 336例HPV相关性与非相关性口咽鳞癌患者生存分析[J]. 中国口腔颌面外科杂志, 2022, 20(4): 378-383.
[15]	杨宋, 王宁, 赵树超, 李恒勇, 葛胜优, 周凯, 宋凯, 尚伟, 冯元勇. Chemerin在合并2型糖尿病口腔鳞癌患者肿瘤中的表达及临床意义[J]. 中国口腔颌面外科杂志, 2022, 20(4): 390-395.