PDF(Pubmed)
Abstract：
The neck management of clinical-nodal negative (cN0) oral squamous cell carcinoma (OSCC) remains controversial. Elective neck dissection (END) and observation are the main strategies, but it is still not clear who could benefit the most from END. The purpose of this study was to clarify the potential clinical factors that affect the therapeutic value of END and to explore the actual characteristics associated with benefit from END.
Patients with cN0 OSCC were identified in the SEER database from 2000 to 2019. 5-year Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan‒Meier method, and the hazard ratios (HRs) for survival were estimated using the Cox regression model. Multiple subgroup analyses of DSS and OS among different factors, comparing END and No END, were performed.
A total of 17,019 patients with cN0 OSCC were included. The basic survival analysis and Cox regression model showed that END increased the probability of 5-year DSS and OS and was an independent prognostic factor. However, among patients who underwent only primary tumor surgery, no significant differences were found between the END and No END groups in 5-year DSS (P = 0. 585) and OS (P = 0.465). Further subgroup analysis showed that primary sites and T stage, but not other factors, might influence the benefit of END. Significant differences were found for T1 (P < 0.001 for OS) and T2 (P = 0.001 for DSS and < 0.001 for OS) tongue squamous cell carcinoma (TSCC) but not for other primary tumor sites.
This large-scale retrospective population-based cohort study suggests that not all patients with cN0 OSCC could benefit from END. Patients with cN0 TSCC are recommended to undergo END, especially with early-stage tumors.
Patients with cN0 OSCC were identified in the SEER database from 2000 to 2019. 5-year Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan‒Meier method, and the hazard ratios (HRs) for survival were estimated using the Cox regression model. Multiple subgroup analyses of DSS and OS among different factors, comparing END and No END, were performed.
A total of 17,019 patients with cN0 OSCC were included. The basic survival analysis and Cox regression model showed that END increased the probability of 5-year DSS and OS and was an independent prognostic factor. However, among patients who underwent only primary tumor surgery, no significant differences were found between the END and No END groups in 5-year DSS (P = 0. 585) and OS (P = 0.465). Further subgroup analysis showed that primary sites and T stage, but not other factors, might influence the benefit of END. Significant differences were found for T1 (P < 0.001 for OS) and T2 (P = 0.001 for DSS and < 0.001 for OS) tongue squamous cell carcinoma (TSCC) but not for other primary tumor sites.
This large-scale retrospective population-based cohort study suggests that not all patients with cN0 OSCC could benefit from END. Patients with cN0 TSCC are recommended to undergo END, especially with early-stage tumors.
摘要：
背景：临床淋巴结阴性（cN0）口腔鳞状细胞癌（OSCC）的颈部管理仍存在争议。选择性颈淋巴结清扫(END)和观察是主要的策略，但目前还不清楚谁能从END中获益最多。这项研究的目的是阐明影响END治疗价值的潜在临床因素，并探讨与END获益相关的实际特征。
方法：在2000年至2019年的SEER数据库中确定了cN0OSCC患者。使用Kaplan-Meier方法分析了5年总生存期（OS）和疾病特异性生存期（DSS），和生存风险比(HR)使用Cox回归模型进行估计。不同因素间DSS和OS的多个亚组分析，比较END和NoEND，被执行了。
结果：共纳入17,019例cN0OSCC患者。基本生存分析和Cox回归模型显示END增加5年DSS和OS的概率,是独立的预后因素。然而,在仅接受原发性肿瘤手术的患者中，在5年DSS中，END和NoEND组之间没有发现显着差异（P=0。585)和OS(P=0.465)。进一步的亚组分析显示，原发位点和T分期，但不是其他因素，可能会影响结束的好处。T1（OS<0.001）和T2（DSSP=0.001，OS<0.001）舌鳞状细胞癌（TSCC）存在显着差异，但其他原发肿瘤部位没有差异。
结论：这项基于人群的大规模回顾性队列研究表明，并非所有cN0OSCC患者都能从END获益。建议患有cN0TSCC的患者进行END，尤其是早期肿瘤.
方法：在2000年至2019年的SEER数据库中确定了cN0OSCC患者。使用Kaplan-Meier方法分析了5年总生存期（OS）和疾病特异性生存期（DSS），和生存风险比(HR)使用Cox回归模型进行估计。不同因素间DSS和OS的多个亚组分析，比较END和NoEND，被执行了。
结果：共纳入17,019例cN0OSCC患者。基本生存分析和Cox回归模型显示END增加5年DSS和OS的概率,是独立的预后因素。然而,在仅接受原发性肿瘤手术的患者中，在5年DSS中，END和NoEND组之间没有发现显着差异（P=0。585)和OS(P=0.465)。进一步的亚组分析显示，原发位点和T分期，但不是其他因素，可能会影响结束的好处。T1（OS<0.001）和T2（DSSP=0.001，OS<0.001）舌鳞状细胞癌（TSCC）存在显着差异，但其他原发肿瘤部位没有差异。
结论：这项基于人群的大规模回顾性队列研究表明，并非所有cN0OSCC患者都能从END获益。建议患有cN0TSCC的患者进行END，尤其是早期肿瘤.
