Department of Pathology, University of Washington, Seattle, WA, USA.
Department of Radiation Oncology, University of California, San Francisco, CA, USA.
Histopathology. 2019 Jan;74(2):321-331. doi: 10.1111/his.13742. Epub 2018 Nov 4.
Cervical lymph node metastasis in head and neck squamous cell carcinoma (HNSCC) is common. Pre-operative chemoradiotherapy (preCRT) and postoperative chemoradiotherapy (postCRT) is frequently employed in such patients. The prognostic value of viable SCC, treatment effect or no SCC in resected lymph nodes in patients who received or did not receive preCRT and postCRT was investigated.
Resected cervical lymph nodes from 146 patients with HNSCC were evaluated for viable SCC, treatment effect or no SCC. Immunostains for Ki67, cyclin D1, caspase 3 and H2AFX were performed on viable SCC or nucleate keratin debris. Clinical and histological data were correlated with tumour recurrence or persistence. Patients with nucleate keratin debris in lymph nodes had outcomes similar to those with diffuse treatment effect and no SCC. Viable tumour in lymph nodes was associated with worse prognosis in patients who received preCRT (P = 0.01). This relative worsening of prognosis was not observed in patients with oropharyngeal SCC or recurrent disease. Lower proliferation index in lymph node SCC was associated with preCRT and with worse outcomes (P = 0.0002). Overall, patients who received preCRT or postCRT had outcomes not significantly different from those who did not.
The presence of viable SCC in cervical lymph nodes has prognostic import when taken in context with the patient's history. Viable SCC in lymph nodes was significantly associated with worse outcome among patients with non-oropharyngeal SCC who received preCRT. Nucleate keratin debris should not be considered viable SCC in lymph nodes.
头颈部鳞状细胞癌（HNSCC）患者常发生颈部淋巴结转移。此类患者常接受术前放化疗（preCRT）和术后放化疗（postCRT）。本研究旨在探讨接受或未接受 preCRT 和 postCRT 的患者，其切除的颈部淋巴结中存活的 SCC、治疗效果或无 SCC 的预后价值、治疗效果或无 SCC。
对 146 例 HNSCC 患者的切除的颈部淋巴结进行了存活 SCC、治疗效果或无 SCC 的评估。对存活 SCC 或有核角蛋白碎片进行 Ki67、cyclin D1、caspase 3 和 H2AFX 的免疫染色。将临床和组织学数据与肿瘤复发或持续情况相关联。淋巴结中有核角蛋白碎片的患者与弥漫性治疗效果和无 SCC 的患者的结局相似。淋巴结中有存活肿瘤与接受 preCRT 的患者预后较差相关（P=0.01）。这种相对恶化的预后在接受或未接受 preCRT 的口咽 SCC 或复发性疾病患者中未观察到。淋巴结 SCC 中较低的增殖指数与 preCRT 和较差的结局相关（P=0.0002）。总体而言，接受 preCRT 或 postCRT 的患者与未接受 preCRT 的患者的结局无显著差异。
在考虑患者病史的情况下，颈部淋巴结中存活 SCC 的存在具有预后意义。接受 preCRT 的非口咽 SCC 患者中，淋巴结中有存活 SCC 与预后较差显著相关。淋巴结中的有核角蛋白碎片不应被视为存活 SCC。
