| Objective:This study retrospectively analyzedthe clinical data ofpatients diagnosed with tongue squamous cell carcinoma treated in our hospital from 2007 to 2015 at the Department of Oral and Maxillofacial Surgery,School of Stomatology,FMMU,to investigate the correlation of tumor invasion pattern andtype 2 diabetes mellitus with TongueSquamous Cell Carcinoma(TSCC),and provide the theoretical basis and therapeutic reference for the prognosis of patients with such diseases.Material and methods:Experimen one The clinical data of patientsdiagnosed withcT1~2N0M0tongue squamous cell carcinoma treated in our hospital from 2007 to 2014 were retrospectively analyzed.HE staining was performed on the tumor specimens and neck lymph nodes of the patients.The grading of multiple histologic parameters as proposed by Anneroth.was used.The appearance of the host/tumor interface at the deepest point of invasion was evaluated using a four-tiered grading system to describe the different degree of tumor malignancy.And then we investigate the relationship between the invasion pattern of early tongue squamous cell carcinoma and the clinicopathological features,lymphatic metastasis and prognosis of patients withTSCC,in order to assess its ability to predict the degree of malignancy and occult metastases of early TSCC.Experiment two Complete clinical and follow-up data of 187 patients diagnosed withTSCC that were initially treated at Department of Oral and Maxillofacial Surgery of FMMU from 2012 to 2015,were retrospectively analyzed.These patients were divided into two groups,31 cases with type 2 diabetes mellitus and 156 cases with non-diabetes.The age,gender,fasting plasma glucose,clinical stage,pathological grade,neck dissectionsurgery rate,metastaticlymph nodes rate,tumor recurrence rate,postoperative complications,average number of days of hospitalization of the two groups were compared and analyzed by reviewing the archived medical records and following upwith these patients by telephone.Results:Experiment one There were 77 patients diagnosed with cT1~2N0M0 tongue squamous cell carcinoma,53.2%of patients were males and 46.8% females.Themedian age of patients was 53 years(26-87 years),27.3%of patients were from urban and 72.7% from rural areas,The rural-urban area ratio was 2.7:1.Among the 77 patients with TSCC,there are 53 patients(68.8%)with carcinomaon the lingual side of the tongue,16 patients(20.7%)on the ventral mucosa of tongue,6 patients(7.8%)onthe dorsum of tongue,2 Patients(2.7%)on theapex of tongue.There are 46 patients(59.7%)with carcinoma of ulcerative type,23(29.9%)with carcinoma ofinfiltrative type,and 8(10.4%)with carcinoma of growth type.As to the precancerous history,34 patients(44.2%)had the history of smoking;9 patients(11.7%)had dentures before they had the history of repeated oral ulcer;6 patients(7.8%)had the history oftrauma caused by foreign matter;6 patients(7.8%)had the history of leukoplakia;and 3 patients(3.9%)had the history of lichen planus;19 patients(24.6%)failed to explain the history of precancerous lesions.According to Anneroth pathological grade,type I 15 cases,accounting for 19.5%;typeII 34 cases,accounting for 44.2%;type III 17 cases,accounting for 22.1%;type IV 11 cases,accounting for 14.2%.There were 19 cases of regional lymph node metastasis,58 cases of negative group,type I 0 cases;type II 3 cases,accounting for 8.82%;type III 8 cases,accounting for 47.06%;type IV 8 cases,accounting for 72.73%,?2=27.758,P=0.000.The lymph node metastasis rate in type I and type II(6.12%)was significantly lowerthan the lymph node metastasis rate in type III andtype IV(57.14%),?2=24.955,P=0.000.Among the 77 cases of tongue squamous cell carcinoma,there were 40 cases(51.9%)of T1 stage,and 37 cases(48.1%)of T2 stage,7 cases(17.5%)of T1 stage with lymph node metastasis positive,12 cases(32.4%)of T2 stage with lymph node metastasis positive,?2=2.306,P=0.129.The total tumor recurrence rate was 9.1%,and the recurrence rate was 2.0% in typeIand type II,and 17.9%.in type III and type IV.?2=6.204,P=0.013.Experiment two These were 31 cases with type 2 diabetes mellitus,accounting for 16.6%,and the history of diabetes was from 3 years up to 16 years.There were 31 cases(19 males and 12 females)with diabetes mellitus,1.6: 1 in male and female;156 in non-diabetic group(85 males and 71 females)and 1.2: 1 in male and female,the difference was not statistically significant(P =0.486).The median age of the two groups was 54 years and 56 years.Diabetes group of age 40 to 60 years accounted for 68%;age distributionof non-diabetic group is more balanced,28 patients wereunder the age of 40,accounting for 17.9%.The fasting blood glucose was(9.86 ± 3.02)mmol / L and(5.85 ± 1.48)mmol / L(P = 0.000)in the diabetic group and non-diabetic group respectively.The ratio of earlyclinical stage(Grade I+Grade II)and late clinical stage(Grade III+Grade IV)was 1: 2.44(9:22)in the diabetic group,and 1.23: 1(86:70)in the non-diabetes mellitus group,the difference was statistically significant(?2 = 7.046,P = 0.008).According to the postoperative pathological results and the histological grade,the well-differentiated TSCCof DM group and Non-DMgroupaccount for 77.4%(24/31),76.9%(120/156);the moderately differentiated TSCC of the two groups account for 19.4%(6/31),21.2%(33/156);the poorly differentiated TSCC of the two groups account for 3.2%(1/31),1.9%(3/156).There was no significant difference in pathological grade(?2 = 0.246,P = 0.884).According to the pathological results and postoperative follow-up visit,the rate of cervical lymphadenectomy of DM group and Non-DM group were 61.3%(19/31)and 59.6%(93/156)respectively,the difference was not statistically significant(?2 = 0.030,P = 0.862).The rate of lymph node metastasis of theDM group and Non-DM group were 25.8%(10/31)and 25.6%(40/156)respectively,the difference was not statistically significant(?2 = 0.000,P = 0.985).The recurrence rates were 32.3%(10/31)and 13.5%(21/156)in the DM group and Non-DM group,the difference was statistically significant(?2 = 6.606,P = 0.01).There were 5 cases(5/31,16.1%)and 7 cases(7/156,4.5%)with postoperative complications in theDM group and Non-DMgroup respectively,the difference was statistically significant(?2 = 5.837,P = 0.016).The most common complication of the DM group was infection in the surgery area.The mean length of hospital stay of the DM group and Non-DMgroup was(17.71 ± 3.40)d and(14.67 ± 4.13)d,respectively,and the difference was statistically significant(t = 7.759,P = 0.006).Conclusions:Experiment oneFrom this study,it is inferred that the lymph node metastasis rate increases with the growth of tumor infiltrating cells from clear boundary expansion to diffuse growth.Especially small tumor cell clumps or single cell could lead cells more easily into the lymphatic system,and form the metastases.Tumor invasion pattern may be a new predictive factor for patients with early tongue squamous cell carcinoma who choose cervical lymphadenectomy.Experiment two Diabetes may be a risk factor for tongue squamous cell carcinoma.Type 2 diabetes mellitus may positively correlate with late clinical stage,high recurrence rate and poor prognosisof TSCC.Blood sugar of patients diagnosed withtongue squamous cell carcinomaandtype 2 diabetes mellitus should be strictly controled in preoperative period,intraoperativeperiod and postoperativeperiod,which will reduce the adverse effects of diabetes on the prognosis of patients. |
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