Abstract：
According to the NCCN guidelines, there is weak evidence to support the use of elective neck dissection (END) in early-stage oral cavity squamous cell carcinoma (OCSCC). We sought to examine the indications for END in patients with cT1N0M0 OCSCC defined according to the AJCC Staging Manual, Eight Edition.
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.
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.
摘要：
目标：根据NCCN指南，缺乏证据支持在早期口腔鳞状细胞癌(OCSCC)中使用选择性颈清扫术(END).我们试图检查根据AJCC分期手册定义的cT1N0M0OCSCC患者的END适应症，八版。
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。
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。
