Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Laryngoscope. 2011 Nov;121(11):2349-58. doi: 10.1002/lary.22186. Epub 2011 Oct 12.
To determine if patients who have undergone an open neck biopsy (a "violated" neck) have improved disease control and survival with completion neck dissection.
Retrospective review of patients who underwent open cervical biopsy for diagnosis prior to definitive treatment between February 1997 and February 2010 at two academic tertiary referral centers.
Ninety-four patients met study criteria, with completion neck dissection performed in 53 patients (56%). The majority of patients (84%) had oropharyngeal tumors. Human papilloma virus (HPV) status was positive in 55 of 63 patients (87%). Chemotherapy was used more often in patients treated nonoperatively (88%) compared to patients who underwent neck dissection (49%; P < .001). Five-year disease-specific survival (DSS) was 84% for patients treated with neck dissection and 82% for nonoperative treatment (P = .5806), and disease-free survival (DFS) was 82% for patients treated with neck dissection and 70% for nonoperative treatment (P = .6047). Five-year DSS was 84% for patients with HPV-positive disease and 63% for HPV-negative disease (P = .0086), and DFS was 79% for HPV-positive disease and 50% for HPV-negative disease (P = .0004). Only advanced primary tumor (T3/T4) stage (hazard ratio [HR] = 8.8, P = .004) was associated with DSS, whereas advanced primary tumor stage (HR = 5.3, P = .008), N3 disease (HR = 5.6, P = .036), and HPV-positive disease (HR = 0.2, P = .032) were significant predictors of DFS, after controlling for all other variables.
In the era of chemoradiation, completion neck dissection following an open cervical biopsy does not appear to provide a survival advantage. A high proportion of HPV-positive oropharyngeal tumors may explain the favorable outcomes observed.
确定接受开放性颈部活检（“侵犯性”颈部）的患者在完成颈部清扫术后，疾病控制和生存是否得到改善。
对 1997 年 2 月至 2010 年 2 月在两个学术三级转诊中心接受开放性颈部活检以明确诊断并进行确定性治疗的患者进行回顾性分析。
94 例患者符合研究标准，其中 53 例（56%）患者接受了完成性颈部清扫术。大多数患者（84%）患有口咽肿瘤。63 例患者中有 55 例（87%）HPV 状态阳性。与接受颈部清扫术的患者（49%；P <.001）相比，接受非手术治疗的患者更常使用化疗（88%）。接受颈部清扫术的患者 5 年疾病特异性生存率（DSS）为 84%，而非手术治疗的患者为 82%（P =.5806），接受颈部清扫术的患者无病生存率（DFS）为 82%，而非手术治疗的患者为 70%（P =.6047）。HPV 阳性疾病患者的 5 年 DSS 为 84%，HPV 阴性疾病患者为 63%（P =.0086），HPV 阳性疾病患者的 DFS 为 79%，HPV 阴性疾病患者为 50%（P =.0004）。仅晚期原发肿瘤（T3/T4 期）（风险比 [HR] = 8.8，P =.004）与 DSS 相关，而晚期原发肿瘤（HR = 5.3，P =.008）、N3 疾病（HR = 5.6，P =.036）和 HPV 阳性疾病（HR = 0.2，P =.032）是 DFS 的显著预测因素，这在控制所有其他变量后仍然成立。
在放化疗时代，开放性颈部活检后进行完成性颈部清扫术似乎并不能带来生存优势。HPV 阳性口咽肿瘤比例较高可能解释了观察到的良好结果。
