Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, Hospital A. C. Camargo, Rua Professor Antonio Prudente no. 211. Liberdade, São Paulo, SP, Brazil.
Braz J Otorhinolaryngol. 2012 Dec;78(6):15-20. doi: 10.5935/1808-8694.20120027.
Neck staging in oral cancer depends on the number of compromised nodes, their size and side of occurrence.
This paper aims to evaluate risk factors for metastatic nodes in levels IV/V and their prognostic impact on patients with oral carcinoma.
Retrospective study.
pathologist's diagnosis of squamous cell carcinoma, primary tumor in the lower oral cavity, no extension into extraoral sites, no previous treatment, synchronous neck dissection and presence of metastatic nodes. Risk factors for metastasis were evaluated through logistic regression and disease-specific survival and recurrence by survival analysis. Classificatory analysis was performed through recursive partitioning.
307 patients met the inclusion criteria. Univariate logistic regression identified pN stage, vascular invasion, and multiple metastatic nodes as risk factors for metastases in levels IV/V. Multivariate analysis found vascular invasion and multiple metastatic nodes were significant. Survival analysis revealed pT, pN, neural infiltration, vascular invasion, number of metastatic nodes, metastases in levels IV/V, and node ratio were significant factors. In multivariate survival analysis, pT, pN, vascular invasion and metastases in levels IV/V were significant. Classificatory analysis showed that pN is non-significant in patients with level IV/V metastases.
The occurrence of metastases in levels IV/V was significant for disease-specific survival.
目的:本文旨在评估 IV/V 水平转移性淋巴结的危险因素及其对口腔癌患者的预后影响。
方法:回顾性研究。
纳入标准:病理诊断为鳞状细胞癌,原发肿瘤位于口腔下部,无口腔外侵犯,无先前治疗,同期行颈部淋巴结清扫术且存在转移性淋巴结。通过逻辑回归评估转移的危险因素,通过生存分析评估疾病特异性生存和复发情况,通过递归分区进行分类分析。
结果:307 例患者符合纳入标准。单因素逻辑回归确定 pN 分期、血管侵犯和多个转移性淋巴结是 IV/V 水平转移的危险因素。多因素分析发现血管侵犯和多个转移性淋巴结是显著的。生存分析显示 pT、pN、神经浸润、血管侵犯、转移性淋巴结数量、IV/V 水平转移和淋巴结比值是显著因素。在多变量生存分析中,pT、pN、血管侵犯和 IV/V 水平转移是显著的。分类分析显示,对于 IV/V 水平转移的患者,pN 无显著性。
结论:IV/V 水平转移的发生对疾病特异性生存有显著影响。