Lee Hojun, Roh Jong-Lyel, Cho Kyung-Ja, Choi Seung-Ho, Nam Soon Yuhl, Kim Sang Yoon
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Surg Oncol. 2019 May;119(6):675-682. doi: 10.1002/jso.25386. Epub 2019 Jan 23.
We compared the predictive ability of our proposed N classification with that of the American Joint Committee on Cancer (AJCC) nodal (N) classification for oral cavity squamous cell carcinoma (OCC).
We assessed 345 OCC patients who underwent primary tumor extirpation and neck lymph node (LN) dissection. N classification was analyzed by recursive partitioning analysis and compared with the AJCC N classification by c-index. Cox proportional hazards regression analyses were used to determine associations between tumor or nodal factors and disease-free survival (DFS) or overall survival (OS).
Positive LNs were found in 149 patients (43.2%). In multivariate models, the number of positive LNs and LN ratio strongly associated with DFS and OS (P < 0.001). Our new N classification was proposed with four categories of N0, N1 (1 positive LN), N2 (2-4 positive LNs or extranodal extension > 2 mm), and N3 (≥5 positive LNs). The c-index for the proposed N classification showed improvement in survival predictions (0.735; 95% CI, 0.703-0.767) compared with the AJCC N classification (0.701; 0.667-0.735).
The number of positive LNs and LN ratios strongly associated with posttreatment recurrence and survival for OCC. Using positive LN numbers with the N classification improves OCC survival predictions.
我们比较了我们提出的N分类与美国癌症联合委员会（AJCC）口腔鳞状细胞癌（OCC）的淋巴结（N）分类的预测能力。
我们评估了345例接受原发性肿瘤切除和颈部淋巴结清扫术的OCC患者。通过递归划分分析对N分类进行分析，并通过c指数与AJCC N分类进行比较。采用Cox比例风险回归分析来确定肿瘤或淋巴结因素与无病生存期（DFS）或总生存期（OS）之间的关联。
149例患者（43.2%）发现阳性淋巴结。在多变量模型中，阳性淋巴结数量和淋巴结比例与DFS和OS密切相关（P < 0.001）。我们提出了新的N分类，分为四类：N0、N1（1个阳性淋巴结）、N2（2 - 4个阳性淋巴结或结外扩展> 2 mm）和N3（≥5个阳性淋巴结）。与AJCC N分类（0.701；0.667 - 0.735）相比，所提出的N分类的c指数在生存预测方面有所改善（0.735；95% CI，0.703 - 0.767）。
阳性淋巴结数量和淋巴结比例与OCC治疗后复发和生存密切相关。将阳性淋巴结数量用于N分类可改善OCC的生存预测。
