Klingelhöffer Christoph, Gründlinger Andreas, Spanier Gerrit, Schreml Stephan, Gottsauner Maximilian, Mueller Steffen, Meier Johannes K, Reichert Torsten E, Ettl Tobias
Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Department of Dermatology, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Oral Maxillofac Surg. 2018 Jun;22(2):185-192. doi: 10.1007/s10006-018-0690-1. Epub 2018 Mar 29.
The purpose of this study was to evaluate the necessity of elective bilateral neck dissection for treating strict unilateral squamous cell carcinoma (SCC) of the tongue.
A cohort of 169 patients with unilateral non-midline crossing SCCs of the tongue treated by local resection and neck dissection was investigated. Study endpoints were nodal relapse and overall survival. The mean follow-up was 7.4 years.
A total of 146 (88.1%) patients were treated by neck dissection. Lymph node metastases were diagnosed in 50 (34.2%) patients. Only two (1.1%) had contralateral lymph node metastases. Risk factors for developing a primary lymph node metastasis were size of tumor (T2/T3, p = 0.03; OR = 2.2), lymphangiosis (p = 0.003; OR = 4.7), and higher-grade differentiation (p = 0.051; OR = 2.43). Metachronous lymph node metastases were detected in 23 (13.6%) patients (19 ipsilateral, one contralateral and three bilateral). The main risk factor for developing a metachronous lymph node metastasis was the presence of a primary lymph node metastasis (p = 0.004; HR = 4.65). Patients with initial neck dissection came up with lower 5-year recurrence rates (13.6%) compared to patients without neck dissection (27.3%; p = 0.014). Bilateral neck dissection showed no advantage regarding nodal relapse free and overall survival (p = 0.606) compared to unilateral neck dissection irrespective of initial N or T stage.
Patients with unilateral SCC of the tongue benefit from an ipsilateral neck dissection regarding nodal relapse. The value of elective bilateral neck dissection as standard treatment seems questionable even if positive lymph nodes were diagnosed ipsilateral at primary therapy.
本研究旨在评估对单侧舌鳞状细胞癌（SCC）进行选择性双侧颈清扫术的必要性。
对169例接受局部切除和颈清扫术治疗的单侧非中线交叉性舌SCC患者进行队列研究。研究终点为淋巴结复发和总生存期。平均随访时间为7.4年。
共有146例（88.1%）患者接受了颈清扫术。50例（34.2%）患者被诊断为淋巴结转移。只有2例（1.1%）有对侧淋巴结转移。发生原发性淋巴结转移的危险因素包括肿瘤大小（T2/T3，p = 0.03；OR = 2.2）、淋巴管浸润（p = 0.003；OR = 4.7）和高分化程度（p = 0.051；OR = 2.43）。23例（13.6%）患者检测到异时性淋巴结转移（19例同侧，1例对侧，3例双侧）。发生异时性淋巴结转移的主要危险因素是存在原发性淋巴结转移（p = 0.004；HR = 4.65）。与未进行颈清扫术的患者相比，初始进行颈清扫术的患者5年复发率较低（13.6%）（27.3%；p = 0.014）。无论初始N或T分期如何，与单侧颈清扫术相比，双侧颈清扫术在无淋巴结复发和总生存期方面均无优势（p = 0.606）。
单侧舌SCC患者在淋巴结复发方面从同侧颈清扫术中获益。即使在初次治疗时同侧诊断出阳性淋巴结，选择性双侧颈清扫术作为标准治疗的价值似乎也值得怀疑。
