Abstract：
BACKGROUND: Selective neck dissection (SND) is the surgical treatment of choice in squamous cell carcinoma of the head and neck (HNSCC) with suspected or manifest metastases in the cervical lymph nodes. For SND to be successful, treated lymph node levels should be selected according to anatomic considerations and the extent of the disease. Aim of this study was to identify neck dissection levels that had an impact on individual prognosis.
METHODS: We conducted a retrospective review of SND as part of primary treatment of HNSCC. Overall survival (OS) and regional control rates (RCR) were calculated for all patients treated at one academic tertiary referral center.
RESULTS: 661 patients with HNSCC were included, 644 underwent ipsilateral and 319 contralateral SND. Average follow-up was 78.9 ± 106.4 months. 67 (10.1%) patients eventually developed nodal recurrence. Tumor sites were oral cavity (135), oropharynx (179), hypopharynx (118) and larynx (229). Tumor categories pT1-pT4a, and all clinical and pathological nodal categories were included. Multivariate analysis indicated improved OS rates for patients undergoing SND in ipsilateral levels I and V as well as level III contralaterally. Analysis for tumor origin showed that SND in ipsilateral level I showed significantly improved OS in HNSCC of the oral cavity.
CONCLUSIONS: The dissection of ipsilateral level I in oral cavity cancer was of particular relevance in our exploratory, retrospective analysis. To clarify the relevance for the determination of the extent of SND, this should be investigated prospectively in a more homogenous patient cohort.
METHODS: We conducted a retrospective review of SND as part of primary treatment of HNSCC. Overall survival (OS) and regional control rates (RCR) were calculated for all patients treated at one academic tertiary referral center.
RESULTS: 661 patients with HNSCC were included, 644 underwent ipsilateral and 319 contralateral SND. Average follow-up was 78.9 ± 106.4 months. 67 (10.1%) patients eventually developed nodal recurrence. Tumor sites were oral cavity (135), oropharynx (179), hypopharynx (118) and larynx (229). Tumor categories pT1-pT4a, and all clinical and pathological nodal categories were included. Multivariate analysis indicated improved OS rates for patients undergoing SND in ipsilateral levels I and V as well as level III contralaterally. Analysis for tumor origin showed that SND in ipsilateral level I showed significantly improved OS in HNSCC of the oral cavity.
CONCLUSIONS: The dissection of ipsilateral level I in oral cavity cancer was of particular relevance in our exploratory, retrospective analysis. To clarify the relevance for the determination of the extent of SND, this should be investigated prospectively in a more homogenous patient cohort.
摘要：
背景：选择性颈淋巴结清扫术（SND）是头颈部鳞状细胞癌（HNSCC）可疑或明显转移的首选手术治疗方法。为了使SND成功，应根据解剖学考虑和疾病的程度选择治疗的淋巴结水平。这项研究的目的是确定对个体预后有影响的颈部夹层水平。
方法：我们对作为HNSCC主要治疗的一部分的SND进行了回顾性回顾。计算在一个学术三级转诊中心治疗的所有患者的总生存率（OS）和区域控制率（RCR）。
结果：纳入661例HNSCC患者，644例接受同侧SND，319例接受对侧SND。平均随访78.9±106.4个月。67例（10.1％）患者最终发生淋巴结复发。肿瘤部位为口腔（135），口咽（179），下咽（118）和喉（229）。肿瘤类别pT1-pT4a，包括所有临床和病理淋巴结类别。多变量分析表明，在同侧I级和V级以及对侧III级接受SND的患者的OS率有所提高。肿瘤起源分析表明，同侧I级SND在口腔HNSCC中显示出显着改善的OS。
结论：口腔癌中同侧I级的解剖在我们的探索中特别相关，回顾性分析。为了澄清与确定SND程度的相关性，这应该在更同质的患者队列中进行前瞻性调查.
方法：我们对作为HNSCC主要治疗的一部分的SND进行了回顾性回顾。计算在一个学术三级转诊中心治疗的所有患者的总生存率（OS）和区域控制率（RCR）。
结果：纳入661例HNSCC患者，644例接受同侧SND，319例接受对侧SND。平均随访78.9±106.4个月。67例（10.1％）患者最终发生淋巴结复发。肿瘤部位为口腔（135），口咽（179），下咽（118）和喉（229）。肿瘤类别pT1-pT4a，包括所有临床和病理淋巴结类别。多变量分析表明，在同侧I级和V级以及对侧III级接受SND的患者的OS率有所提高。肿瘤起源分析表明，同侧I级SND在口腔HNSCC中显示出显着改善的OS。
结论：口腔癌中同侧I级的解剖在我们的探索中特别相关，回顾性分析。为了澄清与确定SND程度的相关性，这应该在更同质的患者队列中进行前瞻性调查.
