Canis Martin, Plüquett Stefan, Ihler Friedrich, Matthias Christoph, Kron Martina, Steiner Wolfgang
Department of Otorhinolaryngology–Head and Neck Surgery, University of Göttingen, Germany.
Arch Otolaryngol Head Neck Surg. 2012 Jul;138(7):650-5. doi: 10.1001/archoto.2012.1026.
To evaluate the impact of elective selective neck dissection vs observation on regional recurrence and survival in cN0-staged patients after transoral microscopic laser surgery of squamous cell carcinomas of the upper aerodigestive tract.
Retrospective unicenter study performed from 1986 through 2003.
Tertiary referral center.
A total of 202 of 425 patients (48%) with previously untreated squamous cell carcinoma of the upper aerodigestive tract (T1-T4) underwent transoral laser surgery and selective neck dissection with curative intent. A total of 223 patients (52%) received tumor resection only. Stage distribution was as follows: stage I, 50 cases (12%); stage II, 216 cases (51%); stage III, 120 cases (28%); and stage IVa, 39 cases (9%).
Overall survival, recurrence-free survival.
In the neck dissection group, 15% of occult metastases were found. In pN0 necks we found 4 late metastases (4%), and in pN+ necks, 1 recurrent neck metastasis (7%) (pT1-pT2) (n = 109). In patients with pT3-pT4 tumors (n = 93), 5 late neck metastases (5%) were observed. The wait-and-see group comprised 7 late metastases (4%) in patients with pT1-pT2 tumors (n = 171) and 9 late metastases (17%) in patients with pT3-pT4 tumors (n = 52). In early-stage T1-T2 tumors, the 5-year recurrence-free survival rate was 95% in the neck dissection group and 96% in the wait-and-see group. Advanced stages T3 to T4 presented a 5-year recurrence-free survival rate of 90% in the neck dissection group and 75% in the wait-and-see group. In early-stage T1-T2 tumors, the 5-year overall survival rate was 83% in the neck dissection group and 72% in the wait-and-see group. Advanced T3-T4 categories showed 5-year overall survival rates of 58% in the neck dissection group and 60% in the wait-and-see group.
A wait-and-see approach is justified in patients with early-stage disease. Elective selective neck dissection should be considered in patients with advanced cancer of the upper aerodigestive tract. Because of selection effects, the possible conclusions of this study are limited. There is a definite need for prospective, randomized studies.
评估选择性颈部清扫术与观察等待对经口显微激光手术治疗上消化道鳞状细胞癌的cN0期患者区域复发及生存的影响。
1986年至2003年进行的回顾性单中心研究。
三级转诊中心。
425例既往未经治疗的上消化道鳞状细胞癌（T1-T4）患者中，共有202例（48%）接受了经口激光手术及选择性颈部清扫术，目的是治愈。共有223例患者（52%）仅接受了肿瘤切除术。分期分布如下：I期，50例（12%）；II期，216例（51%）；III期，120例（28%）；IVa期，39例（9%）。
总生存、无复发生存。
在颈部清扫组中，发现15%的隐匿性转移。在pN0颈部，我们发现4例晚期转移（4%），在pN+颈部，1例复发性颈部转移（7%）（pT1-pT2）（n = 109）。在pT3-pT4肿瘤患者中（n = 93），观察到5例晚期颈部转移（5%）。观察等待组中，pT1-pT2肿瘤患者有7例晚期转移（4%）（n = 171），pT3-pT4肿瘤患者有9例晚期转移（17%）（n = 52）。在早期T1-T2肿瘤中，颈部清扫组的5年无复发生存率为95%，观察等待组为96%。晚期T3至T4期，颈部清扫组的5年无复发生存率为90%，观察等待组为75%。在早期T1-T2肿瘤中，颈部清扫组的5年总生存率为83%，观察等待组为72%。晚期T3-T4组，颈部清扫组的5年总生存率为58%，观察等待组为60%。
对于早期疾病患者，观察等待的方法是合理的。对上消化道晚期癌症患者应考虑选择性颈部清扫术。由于选择效应，本研究的可能结论有限。确实需要进行前瞻性随机研究。
