Lop Joan, Rigó Antoni, Codina Alberto, de Juan Julia, Quer Miquel, León Xavier
Servicio de Otorrinolaringología, Hospital Josep Trueta, Girona, España.
Servicio de Otorrinolaringología, Hospital de Sant Pau, Barcelona, España.
Acta Otorrinolaringol Esp (Engl Ed). 2018 May-Jun;69(3):156-164. doi: 10.1016/j.otorri.2017.07.002. Epub 2017 Oct 13.
Extranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease.
We retrospectively analysed data from 348 head and neck squamous cell carcinoma patients without any previous treatment and lacking clinical or radiological evidence of neck node metastases during the initial workup, treated with an elective neck dissection between 1992-2014. The incidence of occult metastatic neck nodes with extranodal extension and the impact of extranodal extension in survival were evaluated.
The proportion of patients with occult neck node metastases was 33%. Of these, 23.5% had at least one metastatic neck node with extranodal extension. There were significant differences in the disease-specific survival rate according to neck node status. Five-year disease-specific survival for patients without histopathological metastases was 90%, for patients with occult neck node metastases without extranodal extension it was 71.2%, and for patients with occult neck node metastases with extranodal extension it was 25.9% (P=.0001). The multivariate analysis revealed that the presence of occult node metastases with extranodal extension was the factor with strongest impact on survival. The inclusion of the extranodal extension as a criterion of histopathological evaluation in the 8th TNM classification edition improves the prognostic capacity compared to previous TNM editions.
Appearance of metastatic neck nodes with extranodal extension is an adverse prognostic factor in head and neck squamous cell carcinoma patients without clinical evidence of regional disease during the initial workup of the tumour.
淋巴结转移中的结外侵犯是头颈部鳞状细胞癌患者独立的不良预后因素。然而，很少有研究专门针对无淋巴结疾病临床证据的患者亚组。
我们回顾性分析了1992年至2014年间接受择期颈部清扫术的348名头颈部鳞状细胞癌患者的数据，这些患者既往未接受过任何治疗，在初始检查时缺乏颈部淋巴结转移的临床或影像学证据。评估了隐匿性转移性颈部淋巴结伴结外侵犯的发生率以及结外侵犯对生存的影响。
隐匿性颈部淋巴结转移患者的比例为33%。其中，23.5%的患者至少有一个转移性颈部淋巴结伴结外侵犯。根据颈部淋巴结状态，疾病特异性生存率存在显著差异。无组织病理学转移患者的5年疾病特异性生存率为90%，隐匿性颈部淋巴结转移无结外侵犯患者为71.2%，隐匿性颈部淋巴结转移有结外侵犯患者为25.9%（P = 0.0001）。多变量分析显示，隐匿性淋巴结转移伴结外侵犯的存在是对生存影响最强的因素。与之前的TNM版本相比，在第8版TNM分类中将结外侵犯纳入组织病理学评估标准可提高预后能力。
在肿瘤初始检查时无区域疾病临床证据的头颈部鳞状细胞癌患者中，出现转移性颈部淋巴结伴结外侵犯是不良预后因素。
