舌癌における頸部リンパ節転移予測因子に関する病理組織学的研究 Evaluation of prognostic factors for cervical lymph node metastasis of squamous cell carcinoma of the tongue

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舌癌の原発巣における病理組織学的悪性度の評価およびこれらと頸部リンパ節転移との関係について検討をおこなった.深部へ浸潤する癌では組織分化度がより低いものへと変化するものが存在することが確認された.頸部リンパ節転移と有意な関係が確認されたものは, 神経周囲浸潤, 筋層深達度, 最浸潤部での組織分化度であった.神経周囲浸潤と筋層深達度との間には有意な関係が確認され, 神経周囲浸潤が深達度を増加させる因子であることが示唆された.治療方針であるが, 頸部リンパ節転移陰性かつ原発巣の筋層内深達度が7mm未満の例では, まず原発巣切除のみを施行し, 術後の病理組織学的検索で予後を推察したいと考えた.

Forty-four patiants who had squamous cell carcinoma of the tongue, that could examine into the primary lesion and cervical lymph node, were studied. The evaluation of histopathological malignancy in the primary lesion of squamous cell carcinoma of the tongue was discussed, together with how this was related to cervical lymph node metastasis. It has been confirmed that carcinoma invades into the deep layers, carcinoma might become less differentiated.<BR>Histological variables examined included invasion within the muscle layer, length of muscle layer, depth of invasion within the muscle layer, perineural and lymphovascular space invasion, histological differentiation (the whole, the part of invasive front, the change in deep layer).<BR>A statistial association with cervical lymph node metastasis was found in the following factors: the depth of invasion within the muscle layer (p<.01), perineural invasion (p<.01), and grade of histological differentiation in the most invasive lesions (p<.05). It has further been shown that there is a close relationship between perineural invasion and the depth of muscle layer invasion. This suggests that perineural invasion is one factor that enhances the increase in depth of invasion within the muscle layer.<BR>Our treatment policy for the above is that if carcinoma is not metastasis into cervical lymph node and the invasion of the muscle layer is less than 7mm in the primary lesion, we will resect the primary lesion only and then carry out a histopathological study to determine the prognosis.

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  • 口腔・咽頭科 = Stomato-pharyngology

    口腔・咽頭科 = Stomato-pharyngology 13(2), 269-279, 2001-02-28

    日本口腔・咽頭科学会

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