Of the 3886 patients diagnosed with cT1N0M0 included in the study, 2065 underwent END and 1821 neck observation.
The 5-year outcomes for patients who received END versus neck observation before and after propensity score matching (n = 1406 each) were as follows: neck control, 96 %/90 % (before matching), p < 0.0001; 96 %/90 % (after matching), p < 0.0001; disease-specific survival (DSS), 93 %/92 % (before matching), p = 0.0227; 93 %/92 % (after matching), p = 0.1436. Multivariable analyses revealed that neck observation, depth of invasion (DOI) > 2.5 mm, and poor differentiation were independent risk factors for 5-year outcomes. Upon the application of a scoring system ranging from 0 (no risk factor) to 3 (presence of the three risk factors), the following 5-year rates were observed: neck control, 98 %/95 %/84 %/85 %; DSS, 96 %/93 %/88 %/85 %; and overall survival, 90 %/86 %/79 %/59 %, respectively (all p < 0.0001). The survival outcomes of patients with scores of 0 and 1 were similar. The occult metastasis rates in the entire study cohort, DOI > 2.5 mm, and poor differentiation were 6.8 %/9.2 %/17.1 %, respectively.
Because all patients who received neck observation had a score of 1 or higher, END should be performed when a DOI > 2.5 mm or poorly differentiated tumors are present. Under these circumstances, 48.6 % (1888/3886) of cT1N0M0 patients may avoid END without compromising oncological outcomes.
方法:纳入研究的3886例cT1N0M0患者中,2065进行END和1821颈部观察。
结果:在倾向评分匹配之前和之后接受END与颈部观察的患者的5年结局(n=1406)如下:颈部控制,96%/90%(匹配前),p<0.0001;96%/90%(匹配后),p<0.0001;疾病特异性生存率(DSS),93%/92%(匹配前),p=0.0227;93%/92%(匹配后),p=0.1436。多变量分析显示颈部观察,侵入深度(DOI)>2.5mm,分化差是5年结局的独立危险因素.在应用从0(无风险因素)到3(存在三个风险因素)的评分系统时,观察到以下5年比率:颈部控制,98%/95%/84%/85%;DSS,96%/93%/88%/85%;总生存率,90%/86%/79%/59%,分别(所有p<0.0001)。评分为0和1的患者的生存结果相似。整个研究队列中的隐匿性转移率,DOI>2.5mm,分化差为6.8%/9.2%/17.1%,分别。
结论:因为所有接受颈部观察的患者得分为1分或更高,当存在DOI>2.5mm或低分化肿瘤时,应进行END。在这种情况下,48.6%(1888/3886)的cT1N0M0患者可以避免END而不损害肿瘤学结果。