口腔癌中淋巴结比率与区域失败和远处转移的关系。
Lymph node ratio relationship to regional failure and distant metastases in oral cavity cancer.
作者信息
Hosni Ali, McMullen Caitlin, Huang Shao Hui, Xu Wei, Su Jie, Bayley Andrew, Bratman Scott V, Cho John, Giuliani Meredith, Kim John, Ringash Jolie, Waldron John, Spreafico Anna, Weinreb Ilan, de Almeida John R, Brown Dale H, Irish Jonathan C, O'Sullivan Brian, Goldstein David P, Hope Andrew
机构信息
Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada.
Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Canada.
出版信息
Radiother Oncol. 2017 Aug;124(2):225-231. doi: 10.1016/j.radonc.2017.06.018.
BACKGROUND
We aimed to investigate the impact of lymph node ratio (LNR, number of positive nodes/total number of excised nodes) on regional-only-failure, distant-only-failure and overall survival (OS) in oral squamous cell carcinoma (OSCC).
METHODS
Retrospective review of pN0-2 OSCC-patients (1994-2012) treated with curative-surgery with neck dissection±postoperative radiotherapy (PORT)±concurrent chemotherapy. LNR was subjected to multivariable analysis (MVA) of regional-only-failure, distant-only-failure and OS.
RESULTS
Overall 914 patients were identified; median follow-up: 51months (1-189); pN0: 482 (52.7%), pN1: 128 (14%), pN2a: 6 (0.7%); pN2b: 225 (24.6%); pN2c: 73 (8%); median number of dissected nodes: 36 (6-125); median number of pN+: 2 (1-49); median LNR for pN+ patients: 6%; extranodal extension: 187 (20.5%). Bilateral neck dissection: 368 (40.3%); PORT: 452 (49.5%); and concurrent chemotherapy: 80 (8.8%). High grade, lymphovascular invasion perineural invasion and pT3-4 were associated with high LNR. On MVA, LNR was associated with regional-only-failure (HR=1.06; 95%CI: 1.04-1.08; p<0.001), distant-only-failure (HR=1.03; 95%CI: 1.02-1.05; p=0.004) and lower OS (HR=1.03; 95%CI: 1.02-1.05; p<0.001). Similarly, in pN2-subgroup: LNR was associated with regional-only-failure (HR=1.04; 95%CI: 1.02-1.06; p<0.001), distant-only-failure (HR=1.03; 95%CI: 1.01-1.06; p=0.045) and lower OS (HR=1.03; 95%CI: 1.02-1.04; p<0.001).
CONCLUSION
High LNR is associated with higher regional-only-failure/distant-only-failure and lower OS. LNR should be assessed in future prospective trials for selection of adjuvant therapy.
背景
我们旨在研究淋巴结比率（LNR，阳性淋巴结数量/切除淋巴结总数）对口腔鳞状细胞癌（OSCC）区域局部复发、远处转移和总生存期（OS）的影响。
方法
回顾性分析1994年至2012年间接受根治性手术加颈部清扫术±术后放疗（PORT）±同步化疗的pN0-2期OSCC患者。对LNR进行区域局部复发、远处转移和OS的多变量分析（MVA）。
结果
共纳入914例患者；中位随访时间：51个月（1-189个月）；pN0：482例（52.7%），pN1：128例（14%），pN2a：6例（0.7%）；pN2b：225例（24.6%）；pN2c：73例（8%）；中位清扫淋巴结数：36个（6-125个）；中位pN+数：2个（1-49个）；pN+患者的中位LNR：6%；淋巴结外侵犯：187例（20.5%）。双侧颈部清扫：368例（40.3%）；PORT：452例（49.5%）；同步化疗：80例（8.8%）。高分级、淋巴管侵犯、神经周围侵犯和pT3-4与高LNR相关。多变量分析显示，LNR与区域局部复发（HR=1.06；95%CI：1.04-1.08；p<0.001）、远处转移（HR=1.03；95%CI：1.02-1.05；p=0.004）及较低的OS（HR=1.03；95%CI：1.02-1.05；p<0.001）相关。同样，在pN2亚组中：LNR与区域局部复发（HR=1.04；95%CI：1.02-1.06；p<0.001）、远处转移（HR=1.03；95%CI：1.01-1.06；p=0.045）及较低的OS（HR=1.03；95%CI：1.02-1.04；p<0.001）相关。
结论
高LNR与较高的区域局部复发/远处转移及较低的OS相关。未来的前瞻性试验应评估LNR以选择辅助治疗方案。
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