Den Toom Inne J, Bloemena Elisabeth, van Weert Stijn, Karagozoglu K Hakki, Hoekstra Otto S, de Bree Remco
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Eur Arch Otorhinolaryngol. 2017 Feb;274(2):961-968. doi: 10.1007/s00405-016-4280-2. Epub 2016 Aug 25.
To determine risk factors for additional non-sentinel lymph node metastases in neck dissection specimens of patients with early stage oral cancer and a positive sentinel lymph node biopsy (SLNB). A retrospective analysis of 36 previously untreated SLNB positive patients in our institution and investigation of currently available literature of positive SLNB patients in early stage oral cancer was done. Degree of metastatic involvement [classified as isolated tumor cells (ITC), micro- and macrometastasis] of the sentinel lymph node (SLN), the status of other SLNs, and additional non-SLN metastases in neck dissection specimens were analyzed. Of 27 studies, comprising 511 patients with positive SLNs, the pooled prevalence of non-SLN metastasis in patients with positive SLNs was 31 %. Non-SLN metastases were detected (available from 9 studies) in 13, 20, and 40 % of patients with ITC, micro-, and macrometastasis in the SLN, respectively. The probability of non-SLN metastasis seems to be higher in the case of more than one positive SLN (29 vs. 24 %), the absence of negative SLNs (40 vs. 19 %), and a positive SLN ratio of more than 50 % (38 vs. 19 %). Additional non-SLN metastases were found in 31 % of neck dissections following positive SLNB. The presence of multiple positive SLNs, the absence of negative SLNs, and a positive SLN ratio of more than 50 % may be predictive factors for non-SLN metastases. Classification of SLNs into ITC, micro-, and macrometastasis in the future SLNB studies is important to answer the question if treatment of the neck is always needed after positive SLNB.
确定早期口腔癌且前哨淋巴结活检（SLNB）阳性患者颈部清扫标本中出现额外非前哨淋巴结转移的危险因素。对本机构36例既往未经治疗的SLNB阳性患者进行回顾性分析，并对目前有关早期口腔癌SLNB阳性患者的文献进行研究。分析前哨淋巴结（SLN）的转移累及程度[分为孤立肿瘤细胞（ITC）、微转移和宏转移]、其他SLN的状态以及颈部清扫标本中的额外非SLN转移情况。在27项研究（共511例SLN阳性患者）中，SLN阳性患者非SLN转移的合并患病率为31%。在SLN中出现ITC、微转移和宏转移的患者中，分别有13%、20%和40%检测到非SLN转移（来自9项研究）。若存在一个以上阳性SLN（29%对24%）、不存在阴性SLN（40%对19%）以及阳性SLN比例超过50%（38%对19%），非SLN转移的可能性似乎更高。SLNB阳性后，31%的颈部清扫中发现了额外的非SLN转移。存在多个阳性SLN、不存在阴性SLN以及阳性SLN比例超过50%可能是非SLN转移的预测因素。在未来的SLNB研究中，将SLN分为ITC、微转移和宏转移对于回答SLNB阳性后是否总是需要进行颈部治疗这一问题很重要。
