PDF(Pubmed)
Abstract：
Selective neck dissection (SND) is the treatment of choice in patients with oral squamous cell carcinomas (OSCCs) and clinically node-negative necks (cN0). The treatment of patients with positive-staged necks (cN+) includes SND as well as comprehensive neck dissection (CND). The clear benefit of one or the other remains under debate. We aim to address this lack of clarity by analysing patients with OSCC staged with clinically node-positive necks, treated with either CND or SND using a level-by-level approach. This retrospective study included patients diagnosed with OSCC with clinically (cN+) and pathologically (pN+) positive cervical lymph nodes (LNs) with clear neck level categorization during the years 2010-2019. In total, 74 patients were analysed. Cox regression analysis found no significance for the type of ND being an independent risk factor, neither for overall survival (OS) nor for disease-free survival (DFS). Regional recurrence of CND cases (5.77%) was comparable to SND cases (9.09%). For OS, extracapsular spread (ECS) and male sex were identified as independent risk factors with poorer outcome. pT-stage and ECS were found to be independent risk factors for DFS. The results of this study suggest that both CND and SND may be viable treatment options for certain patients with OSCC pN+.
摘要：
选择性颈清扫术（SND）是口腔鳞状细胞癌（OSCC）和临床淋巴结阴性颈（cN0）患者的首选治疗方法。颈部分期(cN+)阳性患者的治疗包括SND以及全面颈清扫术(CND)。一个或另一个的明显好处仍在辩论中。我们的目标是通过分析临床淋巴结阳性颈部的OSCC患者来解决这种缺乏清晰度的问题。使用逐级方法用CND或SND治疗。这项回顾性研究包括2010-2019年间临床（cN）和病理（pN）阳性颈淋巴结（LNs）诊断为OSCC的患者，颈部水平分类清晰。总的来说,对74例患者进行了分析。Cox回归分析发现ND类型是独立的危险因素，无论是总生存期（OS）还是无病生存期（DFS）。CND病例的区域复发（5.77%）与SND病例（9.09%）相当。对于操作系统，囊外扩散(ECS)和男性性别被确定为结局较差的独立危险因素.发现pT分期和ECS是DFS的独立危险因素。这项研究的结果表明，对于某些OSCCpN患者，CND和SND都可能是可行的治疗选择。
