Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Oral Oncol. 2018 Mar;78:94-101. doi: 10.1016/j.oraloncology.2018.01.020. Epub 2018 Feb 20.
Neck failure in patients with oral squamous cell carcinoma (OSCC) carries a poor outcome, yet the management of patients who initially present with clinically node-negative (cN0) neck is not clearly defined.
Retrospective review of patients with cN0 OSCC treated at Memorial Sloan Kettering Cancer Center from 1985 to 2012, focusing on rate, pattern and predictors of neck failure, salvage treatment, and survival outcomes.
Of 1,302 patients, 806 (62%) underwent elective neck dissection (END) and 496 (38%) had observation. 190 patients (15%) developed neck recurrence. Median follow-up was 58.5 months (range 1-343); 5-year neck recurrence-free survival (NRFS) was 85% and 80% for the END and observation group respectively (p = .06). Patients with neck failure had poorer outcomes than patients without neck failure (5-year overall survival, 37% vs. 74% [p < .001]; disease-specific survival [DSS], 41% vs. 91% [p < .001]). Independent predictors of neck failure were smoking, primary tumor subsite (hard palate and upper gum), and extranodal extension. 87% of patients underwent salvage treatment (END: 81.1%; observation: 94%). Salvage surgery with adjuvant (chemo) radiation had better DSS than surgery alone or nonsurgical salvage.
In our cohort of patients with initially cN0 OSCC triaged to END vs. observation using clinical parameters, 15% developed neck failure. Salvage treatment was feasible in most cases but survival was poorer compared to patients without neck failure. Surgery followed by adjuvant (chemo) radiation resulted in the best outcome.
口腔鳞状细胞癌（OSCC）患者的颈部失败预后较差，但对于最初表现为临床淋巴结阴性（cN0）颈部的患者的管理尚不清楚。
回顾性分析 1985 年至 2012 年在 Memorial Sloan Kettering 癌症中心治疗的 cN0 OSCC 患者，重点关注颈部失败的发生率、模式和预测因素、挽救治疗和生存结果。
在 1302 例患者中，806 例（62%）接受了选择性颈部清扫术（END），496 例（38%）接受了观察。190 例（15%）发生颈部复发。中位随访时间为 58.5 个月（范围 1-343）；5 年颈部无复发生存率（NRFS）分别为 END 组和观察组的 85%和 80%（p=0.06）。颈部失败患者的生存结果比无颈部失败患者差（5 年总生存率，37% vs. 74%[p<0.001]；疾病特异性生存率[DSS]，41% vs. 91%[p<0.001]）。颈部失败的独立预测因素是吸烟、原发肿瘤部位（硬腭和上牙龈）和淋巴结外扩散。87%的患者接受了挽救治疗（END：81.1%；观察：94%）。挽救性手术联合辅助（化疗）放疗的 DSS 优于单纯手术或非手术挽救。
在我们的队列中，根据临床参数将最初 cN0 OSCC 患者分为 END 组和观察组，有 15%的患者发生了颈部失败。大多数情况下都可以进行挽救性治疗，但与无颈部失败的患者相比，生存情况较差。手术联合辅助（化疗）放疗的结果最好。
