Michikawa C, Izumo T, Sumino J, Morita T, Ohyama Y, Michi Y, Uzawa N
Maxillofacial Surgery, Maxillofacial Reconstruction and Function, Division of Maxillofacial and Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Service, The Nippon Dental University Hospital, Tokyo, Japan.
Int J Oral Maxillofac Surg. 2018 Jul;47(7):830-835. doi: 10.1016/j.ijom.2017.12.007. Epub 2018 Jan 17.
Extracapsular spread (ECS) of metastatic lymph nodes from oral carcinoma is the most significant prognostic predictor of a poor treatment outcome. However, only a few reports on prognostic factors in ECS-positive cases have been investigated. To address this problem, a detailed examination of ECS pathology was conducted to determine the prognostic factors of oral squamous cell carcinoma (OSCC) with ECS of metastatic lymph nodes. This study involved 63 OSCC patients with at least one pathologically metastatic node with ECS. Among the 229 metastatic lymph nodes, 149 exhibited ECS. Univariate analysis revealed that a poor outcome and recurrence were significantly associated with the number of ECS-positive nodes, density of ECS, and the minor axis of the smallest ECS-positive node. However, multivariate analysis identified only small size of ECS-positive nodes as a significant and independent factor predicting recurrence and a poor outcome. Thus, small size of ECS-positive nodes is the most important prognostic indicator for OSCC with ECS in metastatic lymph nodes. The classification of ECS status using the minor axis of ECS-positive nodes may be useful for further prediction of a poorer prognosis in OSCC cases. Standardization of ECS diagnosis and multicenter prospective studies will be required to confirm and refine these findings.
口腔癌转移性淋巴结的包膜外扩散（ECS）是治疗效果不佳的最重要预后预测指标。然而，关于ECS阳性病例预后因素的报道较少。为了解决这个问题，对ECS病理进行了详细检查，以确定伴有转移性淋巴结ECS的口腔鳞状细胞癌（OSCC）的预后因素。本研究纳入了63例至少有一个病理证实有ECS的转移性淋巴结的OSCC患者。在229个转移性淋巴结中，149个表现出ECS。单因素分析显示，预后不良和复发与ECS阳性淋巴结数量、ECS密度以及最小ECS阳性淋巴结的短轴显著相关。然而，多因素分析仅确定ECS阳性淋巴结的小尺寸是预测复发和预后不良的一个显著且独立的因素。因此，ECS阳性淋巴结的小尺寸是伴有转移性淋巴结ECS的OSCC最重要的预后指标。使用ECS阳性淋巴结短轴对ECS状态进行分类可能有助于进一步预测OSCC病例的较差预后。需要对ECS诊断进行标准化并开展多中心前瞻性研究以证实和完善这些发现。
