Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China.
Ann Surg Oncol. 2013 Jan;20(1):257-66. doi: 10.1245/s10434-012-2580-3. Epub 2012 Aug 8.
To understand the frequency, clinical significance, and benefits of salvage therapy in oral cavity squamous cell carcinoma (OSCC) patients with regional nodal recurrence at unusual sites (prelaryngeal area, parotid area, and retropharyngeal area).
We examined 178 patients with neck recurrence at levels I-V (usual group) and 26 patients outside levels I-V (unusual group). The 5-year survival rates served as the main outcome measure.
Of the 26 unusual group patients, the neck recurrence sites were as follows: 5 at the prelaryngeal area, 13 at the parotid area, and 8 at the retropharyngeal area. Multivariate analyses demonstrated that poor differentiation, pN2, extracapsular spread (ECS), tumor depth≥10 mm, relapse time≤10 months, local recurrence, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year disease-specific survival (DSS), whereas pN2, ECS, tumor depth≥10 mm, relapse time≤10 months, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year overall survival (OS). The 6-month and 18-month survival rates after the N-relapse date for the salvaged-usual group, the salvaged-unusual group, and the nonsalvaged patients were 73%/46%, 40%/0%, and 10%/0% (P<0.0001), respectively [DSS: salvaged-unusual group (hazard ratio/95 % confidence interval), 2.060/1.058-4.008, P=0.033; salvaged-usual group, 6.420/4.340-9.496, P<0.001; OS: salvaged-unusual group, 2.100/1.080-4.081, P=0.029; salvaged-usual group, 6.514/4.418-9.606, P<0.001].
Our findings demonstrate that OSCC patients with regional nodal recurrence at unusual sites had poor outcomes.
了解口腔鳞状细胞癌（OSCC）患者颈部区域淋巴结复发于不常见部位（喉前区、腮腺区和咽后区）的频率、临床意义和挽救治疗的获益。
我们检查了 178 例颈部 I-V 水平复发（常规组）和 26 例非 I-V 水平复发（不常见组）的患者。主要观察指标为 5 年生存率。
26 例不常见组患者的颈部复发部位如下：喉前区 5 例，腮腺区 13 例，咽后区 8 例。多因素分析显示，低分化、pN2、囊外扩散（ECS）、肿瘤深度≥10mm、复发时间≤10 个月、局部复发、不常见部位的颈部复发和远处转移是 5 年疾病特异性生存（DSS）的独立预后因素，而 pN2、ECS、肿瘤深度≥10mm、复发时间≤10 个月、不常见部位的颈部复发和远处转移是 5 年总生存（OS）的独立预后因素。挽救性常规组、挽救性不常见组和未挽救组患者在接受 N 复发治疗后的 6 个月和 18 个月生存率分别为 73%/46%、40%/0%和 10%/0%（P<0.0001）[DSS：挽救性不常见组（风险比/95%置信区间），2.060/1.058-4.008，P=0.033；挽救性常规组，6.420/4.340-9.496，P<0.001；OS：挽救性不常见组，2.100/1.080-4.081，P=0.029；挽救性常规组，6.514/4.418-9.606，P<0.001]。
我们的研究结果表明，颈部区域淋巴结复发于不常见部位的 OSCC 患者预后较差。
