Martínez-Gimeno Carlos, Molinero Antonio Perera, Castro Victoria, Sastre Maria Julia Muñoz, Castro Emilio Espejo, Aguirre-Jaime Armando
Oral and Maxillofacial Surgery Department, Nuestra Señora de Candelaria University Hospital, C/ San Francisco 105, Santa Cruz de Tenerife, Spain.
Head Neck. 2005 Apr;27(4):320-5. doi: 10.1002/hed.20156.
The prediction of neck metastasis from oral squamous cell carcinoma is an unresolved issue. The Martinez-Gimeno Scoring System (MGSS) is an index designed as a predictive aid that may be implemented after analysis of the tumor resection.
A double-blind cohort study was designed and carried out in a tertiary hospital. Seventy-nine consecutive patients diagnosed with squamous cell carcinoma of the oral cavity requiring local resection and neck dissections were included. After tumor resection, the MGSS was applied, and patients were then classified into one of four groups on the basis of the MGSS score: group I, 7 to 12 points; group II, 13 to 16 points; group III, 17 to 20 points; and group IV, 21 to 30 points. After this, pathologic analysis of the neck specimen was performed to detect metastasis. The results, histopathologic analysis of the neck specimens, and previously tabulated MGSS scores were then compared, and on the basis of their results an estimation of the predictive validity of MGSS of neck metastases was obtained. A correlational analysis was performed, comparing metastases to a set of predictive factors, including the MGSS score. A logistic binary regression model that used metastases as the dependent variable was adjusted in an attempt to estimate odd ratios for these factors.
Twenty-six cases displayed metastases. The metastatic nodes measured from 0.5 to 7 cm and were smaller than 1.5 cm in 46% of the cases. The rates of metastases in the four groups were as follows: group 1, 0%; group II, 21%; group III, 50%; and group IV, 67%. MGSS had a sensitivity of 100% (95% confidence interval [CI], 98% to 100%) for predicting metastases from oral squamous cell carcinoma, a specificity of 55% (95% CI, 44% to 66%), an overall efficiency of 73% (95% CI, 63% to 83%), a positive predictive value of 59% (95% CI, 48% to 70%), and a negative predictive value of 100% (95% CI, 98% to 100%). The correlation between various predictive factors and the presence of metastases showed a value of r = .87 (p = .001) with the MGSS score. No correlation was found between the MGSS score and the size of the metastatic lymph node. In the logistic regression model, the MGSS score displayed an odds ratio of 3.5 (95% CI, 1.9-6.3; p = .00001) for the presence of metastases in patients with squamous cell carcinoma of the oral cavity.
The MGSS is a useful index for the prediction of neck node metastases that is applied at the start of the analysis of the tumor resection in patients with squamous cell carcinoma of the oral cavity.
口腔鳞状细胞癌颈部转移的预测是一个尚未解决的问题。马丁内斯 - 希门诺评分系统（MGSS）是一种设计用于辅助预测的指标，可在肿瘤切除分析后应用。
在一家三级医院设计并开展了一项双盲队列研究。纳入了79例连续诊断为口腔鳞状细胞癌需要局部切除和颈部清扫的患者。肿瘤切除后，应用MGSS，然后根据MGSS评分将患者分为四组之一：I组，7至12分；II组，13至16分；III组，17至20分；IV组，21至30分。此后，对颈部标本进行病理分析以检测转移情况。然后比较结果、颈部标本的组织病理学分析以及先前列出的MGSS评分，并根据其结果获得MGSS对颈部转移预测有效性的估计。进行了相关性分析，将转移情况与一组预测因素（包括MGSS评分）进行比较。以转移情况作为因变量的逻辑二元回归模型进行了调整，以试图估计这些因素的比值比。
26例出现转移。转移淋巴结大小为0.5至7厘米，46%的病例小于1.5厘米。四组的转移率如下：I组，0%；II组，21%；III组，50%；IV组，67%。MGSS对口腔鳞状细胞癌转移的预测敏感性为100%（95%置信区间[CI]，98%至100%），特异性为55%（95%CI，44%至66%），总体效率为73%（95%CI，63%至83%），阳性预测值为59%（95%CI，48%至70%），阴性预测值为100%（95%CI，98%至100%）。各种预测因素与转移存在之间的相关性显示与MGSS评分的r值为0.87（p = 0.001）。未发现MGSS评分与转移淋巴结大小之间存在相关性。在逻辑回归模型中，MGSS评分显示口腔鳞状细胞癌患者转移存在的比值比为3.5（95%CI，1.9 - 6.3；p = 0.00001）。
MGSS是预测口腔鳞状细胞癌患者肿瘤切除分析开始时颈部淋巴结转移的有用指标。
