Sydney Head and Neck Cancer Institute and The Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia.
Head Neck. 2012 May;34(5):709-16. doi: 10.1002/hed.21809. Epub 2011 Jul 7.
Management of the node-negative neck in T1 to T2 oral squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to determine if elective neck dissection improves outcomes in thick primary tumors since this reflects current practice in most institutions and has not been specifically addressed in the literature.
Retrospective analysis comparing elective neck dissection versus observation in 153 patients with T1 to T2 N0 oral SCC ≥4 mm thick.
On multivariable analysis, elective neck dissection was a significant predictor of improved regional control (hazard ratio [HR], 0.1; p < .001), disease-specific (HR, 0.1; p < .001), and overall survival (HR, 0.3; p = .001). Regional failure accounted for 22% of disease-related deaths in the elective neck dissection group compared to 92% in the observation arm.
Elective neck dissection is associated with a clinically significant survival advantage in thick T1 to T2 oral SCC by reducing the risk of regional failure, and we support its routine application in these patients.
T1 至 T2 口腔鳞状细胞癌（SCC）的淋巴结阴性颈部管理仍存在争议。本研究旨在确定选择性颈部清扫术是否能改善厚原发性肿瘤的预后，因为这反映了大多数机构的当前实践，并且尚未在文献中专门讨论过。
对 153 例厚度≥4mm 的 T1 至 T2 N0 口腔 SCC 患者进行回顾性分析，比较选择性颈部清扫术与观察。
多变量分析显示，选择性颈部清扫术是改善区域控制（风险比 [HR]，0.1；p<0.001）、疾病特异性（HR，0.1；p<0.001）和总体生存（HR，0.3；p=0.001）的显著预测因素。在选择性颈部清扫术组中，区域失败导致与疾病相关的死亡占 22%，而在观察组中占 92%。
通过降低区域失败的风险，选择性颈部清扫术与厚 T1 至 T2 口腔 SCC 的临床显著生存优势相关，我们支持在这些患者中常规应用。
