Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
Head Neck. 2013 Oct;35(10):1461-7. doi: 10.1002/hed.23172. Epub 2012 Sep 25.
Bilateral neck treatment in oropharyngeal squamous cell carcinoma (OPSCC) is controversial. This study determined the rate of bilateral neck metastases in OPSCC and formulated a neck treatment algorithrm for OPSCC.
In all, 212 consecutive patients with OPSCC underwent ipsilateral level I-V and contralateral I-III or I-V neck dissections. Pathology results were used to identify factors predicting bilateral neck metastases.
A total of 171 patients (81%) had ipsilateral and 41 patients (24%) bilateral neck metastases. Multivariate logistic regression found cT4 and ≥cN2a significantly associated with contralateral neck metastases (p < .05). However, tumor site was not predictive (p > .05). High-risk pathology features predicted contralateral neck disease (p < .05). cN0 and cN1 necks were unlikely to harbor disease in level V (<5%). Both 2- and 5-year contralateral neck recurrence rates were 1% and 2%.
Bilateral neck disease in OPSCC is more common than once thought. Patients with OPSCC with cT4 or cN2a+ would benefit from bilateral neck treatment. Posttreatment high-risk features should guide treatment escalation.
口咽鳞状细胞癌（OPSCC）的双侧颈部治疗存在争议。本研究旨在确定 OPSCC 双侧颈部转移的发生率，并制定 OPSCC 的颈部治疗方案。
共 212 例 OPSCC 患者接受了同侧Ⅰ-Ⅴ 级和对侧Ⅰ-Ⅲ 级或Ⅰ-Ⅴ 级颈淋巴结清扫术。根据病理结果，确定预测双侧颈部转移的因素。
171 例（81%）患者同侧颈部有转移，41 例（24%）患者双侧颈部有转移。多变量逻辑回归发现 cT4 和≥cN2a 与对侧颈部转移显著相关（p<.05）。然而，肿瘤部位无预测性（p>.05）。高危病理特征预测对侧颈部疾病（p<.05）。cN0 和 cN1 颈淋巴结在Ⅴ水平（<5%）不太可能有疾病。2 年和 5 年对侧颈部复发率分别为 1%和 2%。
OPSCC 的双侧颈部疾病比以前认为的更为常见。cT4 或 cN2a+的 OPSCC 患者将从双侧颈部治疗中获益。治疗后高危特征应指导治疗升级。
