Maxillofacial Surgery, Maxillofacial Reconstruction and Function, Division of Maxillofacial and Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
Br J Cancer. 2011 Mar 1;104(5):850-5. doi: 10.1038/bjc.2011.22. Epub 2011 Feb 8.
Extracapsular spread (ECS) of lymph node metastasis in head and neck cancers, including oral squamous cell carcinomas (OSCCs), is known to reflect tumour aggressiveness, and is significantly associated with high rates of loco-regional recurrence, distant metastasis, and poor outcome. The purpose of this study was to confirm ECS as an important prognostic indicator and to determine the significant factors associated with ECS in OSCCs.
We investigated the incidence of ECS and impact of ECS on survival in 127 OSCC patients. To determine the factors significantly correlated with ECS, we examined many factors, including the clinicopathological features of primary tumours, lymph node metastasis, and copy number aberrations of the cyclin D1 gene (CCND1) and epidermal growth factor receptor gene (EGFR) at primary tumours, and evaluated the value of predicting the risk of ECS of the metastatic lymph node.
Kaplan-Meier and multivariate disease-free and overall survival analysis clearly demonstrated that ECS is an independent prognostic factor in OSCCs. Moreover, logistic regression analysis showed that the number of pathologically positive nodes and copy number aberrations of EGFR at the primary tumour are independent predictors of ECS.
The findings suggest that ECS is an independent prognostic factor in OSCCs. Moreover, the number of pathologically positive lymph nodes and EGFR numerical aberrations of the primary tumour were also shown to be excellent predictors of ECS in OSCCs. Preoperative evaluation of EGFR numerical aberrations might therefore be a useful tool for selecting patients at high risk of ECS, who would benefit from targeted aggressive multimodality therapy.
头颈部癌症（包括口腔鳞状细胞癌）的淋巴结转移的囊外扩散（ECS）已知反映了肿瘤的侵袭性，与局部区域复发、远处转移和不良预后的高发生率密切相关。本研究的目的是确认 ECS 作为一个重要的预后指标，并确定与口腔鳞状细胞癌（OSCC）中 ECS 相关的显著因素。
我们研究了 127 例 OSCC 患者中 ECS 的发生率和 ECS 对生存的影响。为了确定与 ECS 显著相关的因素，我们检查了许多因素，包括原发肿瘤的临床病理特征、淋巴结转移以及原发肿瘤中细胞周期蛋白 D1 基因（CCND1）和表皮生长因子受体基因（EGFR）的拷贝数异常，并评估了预测转移性淋巴结 ECS 风险的价值。
Kaplan-Meier 和多变量无病和总生存分析清楚地表明，ECS 是 OSCC 的独立预后因素。此外，逻辑回归分析表明，病理阳性淋巴结的数量和原发肿瘤中 EGFR 的拷贝数异常是 ECS 的独立预测因子。
这些发现表明 ECS 是 OSCC 的独立预后因素。此外，原发肿瘤中病理阳性淋巴结的数量和 EGFR 的数值异常也被证明是 OSCC 中 ECS 的良好预测因子。因此，术前 EGFR 数值异常的评估可能是选择 ECS 风险较高的患者的有用工具，这些患者可能受益于靶向强化多模态治疗。
