目的:对于临床淋巴结阴性(cN0)的上颌口腔鳞状细胞癌(MOSCC)患者,颈清扫术(ND)和临床观察是颈部主要的两种管理策略。然而,与这两种选择相对应的迹象仍然存在争议。本研究旨在阐明影响ND治疗的临床因素,并基于对来自监测的cN0MOSCC患者数据的回顾性分析,确定可能受益于ND的人群的临床特征。流行病学,和结束结果(SEER)数据库。
方法:从2000年至2020年,在SEER数据库中确定了8846例MOSCC患者。Kaplan-Meier方法用于检查总生存期(OS)和疾病特异性生存期(DSS),而风险比(HR)使用逐步多变量Cox回归模型进行估计。此外,进行DSS和OS的多亚组分析以比较ND和无ND。
结果:我们纳入了2,512例cN0MOSCC患者。基本生存分析和Cox回归模型显示,ND是促进DSS和OS的独立预后因素。其他亚组分析显示,原发部位和T期可能会影响ND模式的疗效。此外,T3/T4期的上牙龈鳞状细胞癌(UGSCC)患者(DSSp=0.009,OSp=0.004),硬腭鳞状细胞癌(HPSCC)(DSSp=0.001,OSp<0.001),在OS和DSS中,ND和软腭鳞状细胞癌(SPSCC)(p=0.029)显示出更好的生存益处。尽管如此,在上述原发肿瘤部位的T1/T2阶段,ND和无ND之间的OS和DSS未观察到差异。此外,与无ND组相比,ND组T1/T2期上唇鳞状细胞癌(ULSCC)患者的DSS结局明显更差(p=0.018).然而,T1/T2和T3/T4患者的OS(p=0.140)以及OS(p=0.248)和DSS(p=0.627)没有显着差异。分别。
结论:主动监测可能是管理所有T阶段ULSCC以及早期(T1/T2)UGSCC的可行策略。SPSCC,和HPSCC,只要进行定期和细致的随访。因此,对于中晚期(T3/T4)UGSCC患者,建议并发ND,SPSCC,和HPSCC。
OBJECTIVE: For patients with clinical nodal-negative (cN0) maxillary oral squamous cell carcinoma (MOSCC), neck dissection (ND) and clinical observation are the main two management strategies for the neck. However, the indications corresponding to these two options remain controversial. This study aimed to elucidate the clinical factors affecting ND treatment and to identify clinical characteristics of the population that may benefit from ND based on a retrospective analysis of cN0 MOSCC patient data from the Surveillance, Epidemiology, and End Results (SEER) database.
METHODS: 8846 MOSCC patients were identified in the SEER database from 2000 to 2020. The Kaplan-Meier method was utilized to examine overall survival (OS) and disease-specific survival (DSS), while the hazard ratio (HR) was estimated using the stepwise multivariate Cox regression model. Furthermore, multi-subgroup analyses of DSS and OS were performed to compare ND and No ND.
RESULTS: We included 2,512 cN0 MOSCC patients. Basic survival analysis and Cox regression modeling showed that ND was an independent prognostic factor that promoted DSS and OS. Additional subgroup analyses revealed that the primary site and T-stage might influence the efficacy of ND modality. Moreover, patients with T3/T4 stage of upper gingival squamous cell carcinoma (UGSCC) (DSS p = 0.009, OS p = 0.004), hard palate squamous cell carcinoma (HPSCC) (DSS p = 0.001, OS p < 0.001), and soft palate squamous cell carcinoma (SPSCC) (p = 0.029) showed a better survival benefit with ND in OS and DSS. Nonetheless, no differences were observed in OS and DSS between ND and No ND at the T1/T2 stage of the abovementioned primary tumor sites. Additionally, the DSS outcomes for T1/T2 stage upper lip squamous cell carcinoma (ULSCC) patients were significantly worse in the ND group than in the No ND group (p = 0.018). However, no significant differences were noted in OS (p = 0.140) as well as OS (p = 0.248) and DSS (p = 0.627) for T1/T2 and T3/T4 patients, respectively.
CONCLUSIONS: Active surveillance might be a feasible strategy for managing all T-staged ULSCC as well as early-stage (T1/T2) UGSCC, SPSCC, and HPSCC, provided regular and meticulous follow-up is performed. Hence, concurrent ND is recommended for patients with intermediate to advanced (T3/T4) stage UGSCC, SPSCC, and HPSCC.