（2025）中国专家共识：咀嚼槟榔相关的口腔鳞状细胞癌的管理(英文)解读

Interpretationof2025ChineseExpertConsensusonManagementofArecaNutChewing-RelatedOralSquamousCellCarcinoma

1.BackgroundandSignificanceoftheConsensus

ArecanuthasbeenclassifiedasaGroupIcarcinogenbytheInternationalAgencyforResearchonCancer(IARC).InChina,regionswithhigharecanutconsumptionsuchasHunanandHainanhaveasignificantlyhigherincidenceoforalsquamouscellcarcinoma(OSCC)thanotherregions.Arecanutchewing-relatedOSCCshowsuniquebiologicalbehaviorsandclinicalcharacteristicsthatdiffergreatlyfromtobaccoandalcohol-relatedOSCC.Beforethereleaseofthisconsensus,therewasalackoftargetedstandardizedmanagementspecificationsforthisspecificOSCCsubtypeinclinicalpractice.The2025EnglishversionoftheChineseexpertconsensusisthefirststandardizedmanagementguidelinefocusingonarecanut-relatedOSCCinChina.ItnotonlyfillsthegapinclinicalmanagementofthisdiseaseandprovidesclearactionableguidanceforChineseclinicians,butalsodeliversChineseclinicalexperienceandresearchevidencetotheglobalacademiccommunitythroughEnglishrelease,promotinginternationalacademicexchangesonthisdisease.

2.CoreContentInterpretationoftheConsensus

2.1EpidemiologicalandBiologicalCharacteristics

Basedonsystematiccollationoflarge-scaleepidemiologicaldatafromChina,theconsensusclearlyclarifiesthecoredifferencesbetweenarecanut-relatedOSCCandnon-arecanut-relatedOSCC:First,theaverageonsetageis5to8yearsyounger,andtheproportionofyoungpatientsunder50yearsoldisnearlytwicethatofnon-areca-relatedOSCC;Second,lesionsaremostlyconcentratedinbuccalmucosa,softpalateandgingiva,whichareindirectcontactwitharecanutduringchewing,accountingformorethan75%ofallcases;Third,tumorinvasivenessisstronger,theratesofperineuralinvasionandlymphaticvesselinvasionare30%higherthanthoseofnon-areca-relatedOSCC,andtheprobabilityofoccultcervicallymphnodemetastasisinearlycasesissignificantlyincreased.ThesefundamentalcharacteristicsdeterminethatthemanagementstrategyofthisdiseasecannotfullycopytheplanofordinaryOSCC.

2.2RiskStratificationandEarlyScreening

Theconsensusinnovativelyproposesatargetedriskstratificationsystembasedonarecanutexposure,dividinghigh-riskgroupsintothreelevelsaccordingtochewingyearsanddailyconsumption:lowexposure(chewing<5years,dailyconsumption<10g),mediumexposure(chewing5-10years,dailyconsumption10-20g),andhighexposure(chewing>10years,dailyconsumption>20g).Forhigh-exposuregroups,theconsensusrecommendsoralendoscopicscreeningevery6months,andproposesacombinedscreeningschemeofsalivaryDNAmethylationbiomarkersplusoralendoscopy,whichcanincreasetheearlydetectionrateofOSCCinarecachewersbymorethan25%comparedwithtraditionalvisualinspection.Inaddition,theconsensusemphasizesthatallarecachewerswithoralsubmucosalfibrosis(OSF)mustbeincludedinkeyscreeningobjects,asthecancerationrateofOSFinlong-termchewerscanreachmorethan8%.

2.3DiagnosticandStagingSystem

TheconsensusretainstheAJCCTNMstagingsystemcommonlyusedforOSCC,andaddsarecanutexposurestratificationasanauxiliaryprognosticindicatoronthisbasis.ItclearlypointsoutthatforpatientswiththesameTNMstage,theriskofrecurrenceandmetastasisinpatientswithhigharecaexposureis1.8timesthatofnon-exposedpatients,sotreatmentintensityneedstobeadjustedaccordingly.Forexample,forT1N0OSCCpatientswithhigharecaexposure,cliniciansneedtobealerttothepossibilityofoccultmetastasis,andmustcompleteenhancedMRIorCTexaminationofthenecktoavoidmisseddiagnosis.

2.4MultidisciplinaryTreatmentStrategy

Theconsensusclearlyproposesthatmultidisciplinaryteam(MDT)managementshouldberoutineforarecanut-relatedOSCC,andclarifiesthecoreprinciplesofdifferentialtreatmentcomparedwithordinaryOSCC:(1)Surgicaltreatment:Duetostrongertumorinvasiveness,thesurgicalsafetymarginshouldbe2-3mmwiderthanthatofordinaryOSCC,andtheindicationforprophylacticcervicallymphnodedissectionisrelaxed.ForcN0patientswithhigharecaexposure,prophylacticdissectionoflevelI-IIIcervicallymphnodesisrecommended;(2)Postoperativeadjuvanttherapy:Forhigh-exposurepatients,evenwithnegativeN0,adjuvantradiotherapyorconcurrentchemoradiotherapyisrecommendedifthereareriskfactorssuchasperineuralinvasion;(3)Systemictherapyforadvancedcases:BasedonChinesereal-worlddata,theconsensuspointsoutthattheobjectiveresponserateofPD-1inhibitormonotherapyforarecanut-relatedOSCCisabout10%lowerthanthatofnon-areca-relatedOSCC,soitisrecommendedthatPD-1inhibitorscombinedwithanti-vasculartargeteddrugsbeusedasfirst-linetreatmentforrecurrent/metastaticcases,whichcansignificantlyprolongprogression-freesurvival.

2.5ComplicationManagementandFollow-up

Mostpatientswitharecanut-relatedOSCCarecomplicatedwithoralsubmucosalfibrosis,sotheincidenceofpostoperativecomplicationssuchaslimitedmouthopening,dysphagiaandintractablemucosalulcerissignificantlyhigherthanthatofordinaryOSCC.Theconsensusrecommendsthatfunctionalinterventionshouldbecarriedoutbeforetreatment:patientsstartmouthopeningtraining1-2weeksbeforesurgery,andlocalglucocorticoidinjectionisgiventopatientswithsevereOSFtoimprovebaselinemouthopening.Aftertreatment,regularrehabilitationtrainingshouldbecontinued.Inlong-termfollow-up,attentionshouldbepaidnotonlytotumorrecurrence,butalsotosecondprimarytumorsinotherpartsoftheoralcavity,becauselong-termarecachewingcancausefieldcancerization,andtheriskofsecondprimarytumorsis2.3timesthatofnon-areca-relatedOSCC.

3.GuidingValueforClinicalPractice

Thisconsensusfillsthegapofstandardizedmanagementforarecanutchewing-relatedOSCC,establishestheconceptofsubtype-specificdifferentiatedmanagement,andchangestheprevioussituationofdirectlycopyingthemanagementplanofordinaryOSCC.TheEnglishreleaseoftheconsensusalsoallowsglobalclinicianstounderstandtheclinicalcharacteristicsandmanagementexperienceofthisdiseasebasedonChina'slargesampledata,whichisofgreatsignificanceforimprovingtheoverallmanagementlevelofarecanut-relatedOSCCworldwide.Atthesamet