目的:口腔鳞状细胞癌(OSCC)患者的颈部管理对于肿瘤控制和生存至关重要。然而,对于临床上颈部淋巴结阴性的患者,是否需要行颈部清扫术(ND)存在争议.我们旨在评估隐匿性转移的危险因素,并探讨隐匿性淋巴结转移(LNMs)的存在是否对复发和生存产生影响。
方法:进行了一项回顾性队列研究,包括在遵循德国现行指南的高容量中心接受根治性肿瘤切除术和ND的原发性OSCC患者。根据标准化方法进行ND。
结果:纳入了四百二十一名经手术治疗的OSCC患者。隐匿性转移发生率为14.49%。病理T分期>1(多变量分析,优势比(OR)3.958,p=0.042)和LNM中存在结外延伸(多变量分析,OR0.287,p=0.020)被确定为隐匿性转移的独立危险因素。比较有无隐匿性转移的患者时,无进展生存期无显著差异(对数秩,p=0.297)和总生存率(对数秩,p=0.320)。无同侧颈部复发病例。一名患者发生对侧颈部转移;然而,他最初表现为单侧pT1pN0肿瘤。
结论:总体而言,我们的研究结果表明,应在ND中采用标准化方法进行颈部管理,以维持OSCC患者的生存率并防止颈部复发.
结论:术前无法可靠评估隐匿性转移的危险因素。虽然选择性ND不能保证完全预防颈部复发,它增加了及时清除微转移的可能性或加强了辅助治疗的理由。因此,这种方法改善了临床结局.
OBJECTIVE: Management of the neck in patients with oral squamous cell carcinoma (OSCC) is pivotal to oncologic control and survival. However, there is controversy regarding necessity of neck dissection (ND) in patients with clinically node-negative neck. We aimed to assess risk factors for occult metastasis and to explore whether the presence of occult lymph node metastases (LNMs) has an impact on recurrence and survival.
METHODS: A retrospective cohort study was performed including patients with primary OSCC who underwent radical tumor resection and ND in a high-volume center adhering to the prevailing German guideline. The ND was performed according to a standardized approach.
RESULTS: Four hundred twenty-one patients with primary surgically treated OSCC were included. The incidence of occult metastasis was 14.49%. A pathological T stage > 1 (multivariate analysis, odds ratio (OR) 3.958, p = 0.042) and the presence of extranodal extension in LNMs (multivariate analysis, OR 0.287, p = 0.020) were identified as independent risk factors for occult metastasis. When comparing patients with and without occult metastasis, there were no significant differences in terms of progression-free survival (log-rank, p = 0.297) and overall survival (log-rank, p = 0.320). There were no cases of ipsilateral neck recurrence. One patient developed contralateral neck metastasis; however, he initially presented with a unilateral pT1 pN0 tumor.
CONCLUSIONS: Overall, our findings suggest that conducting a standardized approach in ND should be applied in terms of management of the neck in order to maintain survival rates and to prevent neck recurrence in OSCC patients.
CONCLUSIONS: None of the risk factors for occult metastasis can be reliably assessed preoperatively. Although elective ND does not guarantee the complete prevention of neck recurrence, it increases the likelihood of either timely removal of micrometastases or strengthens the justification for adjuvant therapy. Consequently, this approach leads to improvements in clinical outcomes.