Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
Department for Oral and Craniomaxillofacial Plastic Surgery, University of Cologne, Cologne, Germany.
J Craniomaxillofac Surg. 2017 Dec;45(12):2092-2096. doi: 10.1016/j.jcms.2017.08.020. Epub 2017 Sep 10.
Nodal yield has been demonstrated as a very promising marker for the prognostic outcome of patients with oral squamous cell carcinoma. However, studies on the importance of clinicopathological factors affecting the number of resected lymph nodes are rare, especially for patients without pathologically proven cervical lymph nodes.
Retrospective chart review of 264 patients with treatment naive oral squamous cell carcinoma and histopathologically proven negative cervical lymph node status, who received selective neck dissection of levels I-III/IV. Exclusion criteria were neoadjuvant chemoradiotherapy, comprehensive or bilateral neck dissection, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed by using univariate and multivariate analysis.
The mean nodal yield was 22.31 with a standard deviation of 16.01 and a mean number of 17 nodes. Gender (p = 0.018), age (p = 0.03), tumor classification (p < 0.001) and perineural invasion (p = 0.012) were significantly associated with nodal yield. Multivariate analysis indicated T-classification (p = 0.049) and age (p = 0.020) as independent factors. Nodal yield was significantly associated with locoregional recurrence (p = 0.041; Cutoff value = 17).
Advanced age and T-classification independently affect lymph node yields in patients with oral squamous cell carcinoma. Hence, they have to be considered for interpretation of both nodal yield and recommended minimum lymph node counts. Furthermore, resection of more than 17 lymph nodes is associated with a significantly lower risk of locoregional recurrence.
淋巴结转移率已被证明是预测口腔鳞状细胞癌患者预后的一个非常有前途的标志物。然而，关于影响淋巴结清扫数量的临床病理因素的重要性的研究很少，特别是对于没有病理证实的颈部淋巴结转移的患者。
回顾性分析 264 例治疗初发的口腔鳞状细胞癌且病理证实无颈部淋巴结转移的患者，这些患者接受了 I-III/IV 区选择性颈淋巴结清扫术。排除标准为新辅助放化疗、综合或双侧颈淋巴结清扫、T4b 分类、围手术期死亡、不可切除的疾病、同步恶性肿瘤、随访<3 个月和不能正确确定淋巴结转移率的信息不足。使用单变量和多变量分析进行统计分析。
平均淋巴结转移率为 22.31，标准差为 16.01，平均淋巴结转移数为 17 个。性别（p=0.018）、年龄（p=0.03）、肿瘤分级（p<0.001）和神经周围侵犯（p=0.012）与淋巴结转移率显著相关。多变量分析表明 T 分类（p=0.049）和年龄（p=0.020）是独立因素。淋巴结转移率与局部区域复发显著相关（p=0.041；临界值=17）。
年龄和 T 分类独立影响口腔鳞状细胞癌患者的淋巴结转移率。因此，在解释淋巴结转移率和推荐的最小淋巴结计数时，必须考虑这些因素。此外，切除超过 17 个淋巴结与局部区域复发的风险显著降低相关。
