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研究生:賴悠仕
研究生(外文):Yu-Shih Lai
論文名稱:腫瘤深度及病理學變項對T1, T2舌鱗狀上皮細胞癌之頸部淋巴結轉移的評估
論文名稱(外文):Prediction of Tumor Depth and Pathological Parameters for Cervical Lymph Node Metastasis in Patients with T1, T2 Tongue Squamous Cell Carcinoma
指導教授:張文正
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:57
中文關鍵詞:腫瘤深度舌鱗狀上皮細胞癌部淋巴結轉移
外文關鍵詞:Tumor DepthTongue Squamous Cell CarcinomaCervical Lymph Node Metastasis
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台灣地區口腔癌患者,於近年來有逐漸增加的趨勢。而且男性增加最多的癌症即為口腔癌,其中主要與男性之吸菸、嚼檳榔與飲酒行為有關。在台灣,口腔癌更成為青壯年男性最常見罹患的癌症。
根據近年來的研究報告中指出,舌上皮細胞癌發生率,不管在世界其他各國或是台灣,都是所有口腔癌中最高。所以舌鱗狀上皮細胞癌的預防及治療評估應該更加被重視及研究。
以頭頸部鱗狀上皮細胞癌的預後因子而言,是否頸部淋巴結轉移佔了十分重要的影響地位,所以選擇適當的頸部淋巴結治療處理,也成為癌症醫療的關鍵。由於口腔舌部分擁有豐富的淋巴引流,故具有更高頸部淋巴結轉移的機會。然而,對低風險性(T1, T2)舌鱗狀上皮細胞癌,且臨床上頸部顯示無淋巴結轉移的病患而言,是否予以頸部淋巴結治療,並無可靠的依據。導致可能於初次治療計畫時,發生頸部淋巴結過度或不足的治療評估
故此研究以舌鱗狀上皮細胞癌病患原發處腫瘤手術之組織發現,來分析此些病理變化對於癌細胞頸部轉移的影響程度大小。其中,以腫瘤侵犯深度的勝算比最高。再求得一評分預測模式:預測分數=2.694×腫瘤深度+1.814×腫瘤淋巴血管侵犯+1.175×腫瘤神經周邊侵犯及預測分數2.7427。
以此來作為T1, T2舌鱗狀上皮細胞癌病患之頸部淋巴結轉移可能性判斷依據時,敏感度為91.2%;特異性為65.4%。與單純考慮腫瘤深度及傳統T-stage做比較,都有較佳的診斷率。
所以,用此研究統計所得的評分預測模式,可以針對低風險性(T1, T2)舌鱗狀上皮細胞癌病患,是否頸部淋巴結轉移的判斷,提供一個有效且可靠的評估,以減少不必要的頸部淋巴結廓清手術所帶來的併發症風險和醫療浪費。


The patients of oral cancer in Taiwan has increased gradually in the recent years. Moreover the most increased cancers in men is the oral cancer, and mainly relative to smoking, betal nut chewing, alcohol drinking . In Taiwan, the oral cancer has become the most common cancer in young adults.
According to the recent researches, the incidence of oral tongue squamous cell carcinoma, regardless of other countries in the world or Taiwan, is the highest of all oral cancers. Therefore, the prevention and treatment evaluation of oral tongue squamous cell carcinoma should be more valued.
Neck lymph node metastasis of head and neck squamous cell carcinoma is the very important factor in prognosis. So to select the appropriate neck lymph node therapy has become the key point of cancer treatment. As the oral tongue has the rich lymphatic drainage, higher opportunity of cervical lymph node metastasis will be happened. However, there is no reliable basis whether to treat neck lymph node in patients of low risk (T1, T2) tongue squamous cell carcinoma without clinical neck lymph node metastasis (N0). As a result, it may lead to the excessive or inadequate treatment assessment of cervical lymph node in the initial treatment plan.
Therefore, we use the histological findings of primary tumor to analyzes the pathological change and the influences of cervical lymph node metastasis in patients with T1, T2 tongue cancer. The odds ratio of tumor invasion depth is the highest in all variables. Then a predictive scoring model was obtained:score = 2.694 × (depth) + 1.814 ×(lymphovascular invasion) + 1.175 × (perineural invasion). Cervical lymph node metastasis was regarded as positive with the score >2.7427.
When we predicted the cervical lymph node metastasis in patients with T1, T2 tongue squamous cell carcinoma by the model, it show good sensitivity and acceptable specificity compared with only tumor depth or traditional T-stage classification.
So, this predictive scoring model was effective and reliable to evaluate the cervical lymph node metastasis in patients with low risk tongue squamous cell carcinoma, and could reduce the risk of complication and medical wasting after performing unnecessary neck dissection.



英文縮寫 I
中文摘要 II
英文摘要 IV
壹、導論 1
一、台灣口腔舌癌之疾病嚴重程度及發生原因 1
1. 台灣口腔癌之發生率 1
2. 台灣口腔癌之發生原因 1
3. 台灣及世界的舌鱗狀上皮細胞癌 2
二、舌鱗狀上皮細胞癌頸部淋巴結轉移對預後之影響及治療 3
1. 頭頸部鱗狀上皮細胞癌的預後因子 3
2. 舌鱗狀上皮細胞癌頸部的淋巴結轉移 4
三、舌鱗狀上皮細胞癌之檢查及治療 4
1. 舌鱗狀上皮細胞癌之臨床檢查 4
2. 舌鱗狀上皮細胞癌頸部淋巴結之治療觀念及頸部淋巴結廓清手術的相關併發症 6
3. 舌鱗狀上皮細胞癌頸部淋巴結轉移之評估 8
貳、研究構想 10
參、研究材料與方法 12
一、研究材料 12
二、研究方法 13
三、統計方法 15
肆、結果 19
一、樣本分析 19
二、單變項邏輯式迴歸分析 20
三、多變項邏輯式迴歸分析 21
四、建立評分預測模式 22
五、計算預測分數 22
六、診斷率之評估 23
伍、討論 25
一、利用腫瘤深度及病理學變項可以評估T1, T2舌鱗狀上皮細胞癌的頸部淋巴結轉移 25
二、評估T1, T2舌鱗狀上皮細胞癌是否有頸部淋巴結轉移的目的 29
三、未來展望 31
陸、結論 32
柒、參考文獻 34
捌、表 43
表1:原發處腫瘤大小的分期 43
表2:區域淋巴轉移的分期 44
表3a:研究中所有類別變項之統計 45
表3b:研究中所有連續變項之統計 45
表4:利用Student t-test來分析其中之連續變項是否頸部淋巴結轉移 46
表5:利用Fisher''s exact test with 2 tailed analysis來分析其中之類別變項是否頸部淋巴結轉移 47
表6:單變項邏輯式迴歸分析 48
表7:多變項邏輯式迴歸分析 49
表8:Youden’s index 50
表9:診斷率之評估 51
玖、圖 52
圖1:利用receiver operating characteristic (ROC) curve來決定最佳診斷截斷點 52
拾、附圖 53
附圖1:T1舌鱗狀上皮細胞癌照片,呈現左側潰瘍性腫塊 53
附圖2:舌癌患者接受雙側頸部淋巴廓清手術及術後 54
附圖3:頸部淋巴結分布的區域 55
附圖4:NCCN (National Comprehensive cancer network) Guideline Version 1.2012 Cancer of the Oral cavity 56
附圖5:本研究採取之腫瘤侵犯深度評估 57


行政院衛生署,民國97年癌症登記報告;台北:行政院衛生署

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