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Abstract：
BACKGROUND: The current NCCN guidelines recommend considering elective neck dissection (END) for early-stage oral cavity squamous cell carcinoma (OCSCC) with a depth of invasion (DOI) exceeding 3 mm. However, this DOI threshold, determined by evaluating the occult lymph node metastatic rate, lacks robust supporting evidence regarding its impact on patient outcomes. In this nationwide study, we sought to explore the specific indications for END in patients diagnosed with OCSCC at stage cT2N0M0, as defined by the AJCC Eighth Edition staging criteria.
METHODS: We examined 4723 patients with cT2N0M0 OCSCC, of which 3744 underwent END and 979 were monitored through neck observation (NO).
RESULTS: Patients who underwent END had better 5-year outcomes compared to those in the NO group. The END group had higher rates of neck control (95% vs. 84%, p < 0.0001), disease-specific survival (DSS; 87% vs. 84%, p = 0.0259), and overall survival (OS; 79% vs. 73%, p = 0.0002). Multivariable analysis identified NO, DOI ≥5.0 mm, and moderate-to-poor tumor differentiation as independent risk factors for 5-year neck control, DSS, and OS. Based on these prognostic variables, three distinct outcome subgroups were identified within the NO group. These included a low-risk subgroup (DOI <5 mm plus well-differentiated tumor), an intermediate-risk subgroup (DOI ≥5.0 mm or moderately differentiated tumor), and a high-risk subgroup (poorly differentiated tumor or DOI ≥5.0 mm plus moderately differentiated tumor). Notably, the 5-year survival outcomes (neck control/DSS/OS) for the low-risk subgroup within the NO group (97%/95%/85%, n = 251) were not inferior to those of the END group (95%/87%/79%).
CONCLUSIONS: By implementing risk stratification within the NO group, we found that 26% (251/979) of low-risk patients achieved outcomes similar to those in the END group. Therefore, when making decisions regarding the implementation of END in patients with cT2N0M0 OCSCC, factors such as DOI and tumor differentiation should be taken into account.
METHODS: We examined 4723 patients with cT2N0M0 OCSCC, of which 3744 underwent END and 979 were monitored through neck observation (NO).
RESULTS: Patients who underwent END had better 5-year outcomes compared to those in the NO group. The END group had higher rates of neck control (95% vs. 84%, p < 0.0001), disease-specific survival (DSS; 87% vs. 84%, p = 0.0259), and overall survival (OS; 79% vs. 73%, p = 0.0002). Multivariable analysis identified NO, DOI ≥5.0 mm, and moderate-to-poor tumor differentiation as independent risk factors for 5-year neck control, DSS, and OS. Based on these prognostic variables, three distinct outcome subgroups were identified within the NO group. These included a low-risk subgroup (DOI <5 mm plus well-differentiated tumor), an intermediate-risk subgroup (DOI ≥5.0 mm or moderately differentiated tumor), and a high-risk subgroup (poorly differentiated tumor or DOI ≥5.0 mm plus moderately differentiated tumor). Notably, the 5-year survival outcomes (neck control/DSS/OS) for the low-risk subgroup within the NO group (97%/95%/85%, n = 251) were not inferior to those of the END group (95%/87%/79%).
CONCLUSIONS: By implementing risk stratification within the NO group, we found that 26% (251/979) of low-risk patients achieved outcomes similar to those in the END group. Therefore, when making decisions regarding the implementation of END in patients with cT2N0M0 OCSCC, factors such as DOI and tumor differentiation should be taken into account.
摘要：
背景：当前的NCCN指南建议考虑对浸润深度（DOI）超过3mm的早期口腔鳞状细胞癌（OCSCC）进行选择性颈淋巴结清扫术（END）。然而,这个DOI阈值，通过评估隐匿性淋巴结转移率来确定，缺乏关于其对患者预后影响的有力支持证据。在这项全国性的研究中，根据AJCC第八版分期标准的定义,我们试图探索在cT2N0M0期诊断为OCSCC的患者中END的具体适应症.
方法：我们检查了4723例cT2N0M0OCSCC患者，其中3744例接受END，979例通过颈部观察进行监测（NO）。
结果：与NO组相比，接受END的患者5年预后更好。END组的颈部控制率更高(95%vs.84%,p<0.0001),疾病特异性生存率（DSS；87%vs.84%,p=0.0259),和总生存率（OS；79%vs.73%,p=0.0002)。多变量分析确定NO，DOI≥5.0mm,肿瘤分化和中差是5年颈部控制的独立危险因素，DSS,和OS。基于这些预后变量，在NO组中确定了三个不同的结局亚组.这些包括低危亚组（DOI<5mm加上高分化肿瘤），中危亚组（DOI≥5.0mm或中分化肿瘤），和高风险亚组（低分化肿瘤或DOI≥5.0mm加上中分化肿瘤）。值得注意的是,NO组中低风险亚组的5年生存结局（颈部控制/DSS/OS）（97％/95％/85％，n=251）不亚于END组（95％/87％/79％）。
结论：通过在NO组中实施风险分层，我们发现,26%(251/979)的低危患者获得了与END组相似的结局.因此,在决定在cT2N0M0OCSCC患者中实施END时，应考虑DOI和肿瘤分化等因素。
方法：我们检查了4723例cT2N0M0OCSCC患者，其中3744例接受END，979例通过颈部观察进行监测（NO）。
结果：与NO组相比，接受END的患者5年预后更好。END组的颈部控制率更高(95%vs.84%,p<0.0001),疾病特异性生存率（DSS；87%vs.84%,p=0.0259),和总生存率（OS；79%vs.73%,p=0.0002)。多变量分析确定NO，DOI≥5.0mm,肿瘤分化和中差是5年颈部控制的独立危险因素，DSS,和OS。基于这些预后变量，在NO组中确定了三个不同的结局亚组.这些包括低危亚组（DOI<5mm加上高分化肿瘤），中危亚组（DOI≥5.0mm或中分化肿瘤），和高风险亚组（低分化肿瘤或DOI≥5.0mm加上中分化肿瘤）。值得注意的是,NO组中低风险亚组的5年生存结局（颈部控制/DSS/OS）（97％/95％/85％，n=251）不亚于END组（95％/87％/79％）。
结论：通过在NO组中实施风险分层，我们发现,26%(251/979)的低危患者获得了与END组相似的结局.因此,在决定在cT2N0M0OCSCC患者中实施END时，应考虑DOI和肿瘤分化等因素。
