Capote-Moreno Ana, Naval Luís, Muñoz-Guerra Mario F, Sastre Jesús, Rodríguez-Campo Francisco J
Attending Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain.
J Oral Maxillofac Surg. 2010 Feb;68(2):268-75. doi: 10.1016/j.joms.2009.09.071.
The prognostic influence of different clinicopathologic factors in contralateral lymph node metastases of oral and oropharyngeal squamous cell carcinoma (SCC) has been rarely described in the literature. Prediction of these contralateral metastases may be of relevance because this factor is strongly associated with poor prognosis. This study analyzed the relationship between predictor factors and the development of contralateral metastases in oral and oropharyngeal SCC.
A series of 402 cases of oral and oropharyngeal SCC were analyzed retrospectively. Unilateral neck dissection was carried out in 190 patients, bilateral neck dissection in 101, and tumor resection without neck dissection in 111. The log-rank test was used for survival analysis of contralateral metastases. Correlation between different clinicopathologic factors and the presence of contralateral metastases was studied with the chi(2) test for univariate analysis and logistic regression for association of these factors and contralateral metastases in the multivariate analysis (P < .05).
Of the patients, 20 (5.1%) had primary positive contralateral metastases in neck dissection specimens and 19 (4.8%) had contralateral recurrences at follow-up. When the 2 groups were taken into consideration, the rate of contralateral metastases of the series was 9%. Gender, tumor location, homolateral positive nodes, tumor extension across the midline, histologic grade, margin status, pattern of growth, and perineural spread were correlated with contralateral metastases in the univariate analysis (P < .05). However, homolateral lymph node metastases and extension across the midline were the most important predictors of contralateral metastases (P < .01) on multivariate logistic regression analysis. Positive contralateral metastases showed a strong correlation with a poor prognosis for survival in this study (P < .05).
Oral and oropharyngeal carcinomas with homolateral positive lymph nodes and tumor extension across the midline are at higher risk of contralateral lymph node involvement. Prediction of contralateral metastases may be useful in planning more aggressive therapies in patients with head and neck SCC with poor prognostic criteria.
口腔和口咽鳞状细胞癌（SCC）对侧淋巴结转移中不同临床病理因素的预后影响在文献中鲜有描述。对这些对侧转移的预测可能具有重要意义，因为该因素与预后不良密切相关。本研究分析了口腔和口咽SCC中预测因素与对侧转移发生之间的关系。
回顾性分析402例口腔和口咽SCC病例。190例患者行单侧颈清扫术，101例患者行双侧颈清扫术，111例患者行肿瘤切除未行颈清扫术。采用对数秩检验对对侧转移进行生存分析。通过卡方检验进行单因素分析，研究不同临床病理因素与对侧转移的相关性，并在多因素分析中采用逻辑回归分析这些因素与对侧转移的关联（P <.05）。
在患者中，20例（5.1%）在颈清扫标本中出现原发性对侧阳性转移，19例（4.8%）在随访中出现对侧复发。将这两组考虑在内时，该系列的对侧转移率为9%。在单因素分析中，性别、肿瘤位置、同侧阳性淋巴结、肿瘤跨越中线、组织学分级、切缘状态、生长模式和神经周围扩散与对侧转移相关（P <.05）。然而，在多因素逻辑回归分析中，同侧淋巴结转移和跨越中线是对侧转移最重要的预测因素（P <.01）。在本研究中，对侧阳性转移与生存预后不良密切相关（P <.05）。
同侧阳性淋巴结且肿瘤跨越中线的口腔和口咽癌发生对侧淋巴结受累的风险更高。对侧转移的预测可能有助于为预后标准较差的头颈部SCC患者制定更积极的治疗方案。
