化放疗后计划性颈清扫术中外囊侵犯的预后作用。
Prognostic role of extracapsular spread in planned neck dissection after chemoradiotherapy.
机构信息
Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
出版信息
Head Neck. 2018 Nov;40(11):2514-2520. doi: 10.1002/hed.25390. Epub 2018 Oct 11.
BACKGROUND
The purpose of this study is to evaluate the prognostic significance of nodes with extracapsular spread (ECS) in patients treated with a planned neck dissection after chemoradiotherapy.
METHODS
We carried out a retrospective study of 109 cN+ patients who achieved a complete response in the primary location after chemoradiotherapy and treated with a planned neck dissection.
RESULTS
The 5-year disease-specific survival for patients without residual metastatic nodes in the neck dissection (pN0, n = 69) was 75.7% (95% CI: 64.4%-87.0%). For patients with metastatic nodes without ECS (pN+/ECS-negative, n = 17), the corresponding figure was 74.0% (95% CI: 48.2%-99.8%), and for patients with metastatic neck nodes with ECS (pN+/ECS-positive, n = 23) it was 8.7% (95% CI: 0.0%-24.3%) (P = .0001).
CONCLUSION
The presence of ECS in the pathologic study of the planned neck dissections carried out after chemoradiotherapy in patients with human papillomavirus-negative (HPV-negative) head and neck squamous cell carcinoma (SCC) allows identification of a group of patients with a high risk of failure.
背景
本研究旨在评估接受放化疗后计划行颈清扫术的患者中，颈部淋巴结包膜外扩散（ECS）的淋巴结对预后的影响。
方法
我们对 109 例经放化疗后原发灶完全缓解且行计划颈清扫术的 cN+患者进行了回顾性研究。
结果
颈清扫术未发现残留转移性淋巴结（pN0，n=69）的患者 5 年疾病特异性生存率为 75.7%（95%CI：64.4%-87.0%）。无 ECS 的转移性淋巴结（pN+/ECS-，n=17）的相应生存率为 74.0%（95%CI：48.2%-99.8%），而有 ECS 的转移性颈部淋巴结（pN+/ECS+，n=23）的生存率为 8.7%（95%CI：0.0%-24.3%）（P=0.0001）。
结论
HPV 阴性头颈部鳞状细胞癌（SCC）患者接受放化疗后，计划行颈清扫术的病理研究中存在 ECS 可识别出一组复发风险较高的患者。
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