Pedemonte G, Esteller E, Villatoro J-C, Costa J-M, Valero C, Quer M, León X
Otorhinolaryngology Department, Hospital Mutua de Terrassa, Terrassa, Barcelona, Spain.
Otorhinolaryngology Department, Hospital General de Catalunya, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
Acta Otorhinolaryngol Ital. 2018 Apr;38(2):86-93. doi: 10.14639/0392-100X-1378.
Elective neck dissection in patients with recurrent head and neck squamous cell carcinoma (HNSCC) without evidence of neck disease (crN0) is poorly defined. A retrospective review was carried out on 165 crN0 patients treated with salvage surgery and elective neck dissection. Multivariate Cox analysis and recursive partitioning analysis were used to evaluate prognostic factors. The frequency of occult neck node metastases in the neck dissection (rpN+) was 16.4%. The risk of occult metastases for glottic rpT1-T2 recurrences was 5.9%, for glottic rpT3-T4 recurrences 13.2%, for non-glottic rpT1-T2 recurrences 16.1% and for locally advanced (rpT3-T4) non-glottic recurrences 31.1%. Patients with occult neck node metastases (rpN+) had a 5-year adjusted survival rate of 38.1%, while patients without nodal disease (rpN0) had a 5-year adjusted survival rate of 71.1% (p = 0.0001). Elective neck dissection can be omitted in crN0 patients with rT1-T2 glottic recurrence. We consider it advisable to perform elective neck dissection in all other situations.
对于无颈部疾病证据（临床N0）的复发性头颈部鳞状细胞癌（HNSCC）患者，选择性颈部清扫术的定义尚不明确。对165例接受挽救性手术和选择性颈部清扫术的临床N0患者进行了回顾性研究。采用多因素Cox分析和递归划分分析来评估预后因素。颈部清扫术中隐匿性颈部淋巴结转移（病理N+）的发生率为16.4%。声门型病理T1-T2复发患者隐匿性转移的风险为5.9%，声门型病理T3-T4复发患者为13.2%，非声门型病理T1-T2复发患者为16.1%，局部晚期（病理T3-T4）非声门型复发患者为31.1%。隐匿性颈部淋巴结转移（病理N+）患者的5年调整生存率为38.1%，而无淋巴结疾病（病理N0）患者的5年调整生存率为71.1%（p = 0.0001）。对于病理T1-T2声门型复发的临床N0患者，可以省略选择性颈部清扫术。我们认为在所有其他情况下进行选择性颈部清扫术是可取的。
