Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Head Neck. 2019 Jun;41(6):1935-1942. doi: 10.1002/hed.25633. Epub 2019 Feb 24.
We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC).
Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease-specific survival (DSS) in a multi-institutional international cohort of 1409 patients with oral SCC ≤4 cm in size treated between 1990-2011.
In patients without other adverse factors (nodal metastases; close [<5 mm] or involved margins), there was no association between DOI and DSS, with an excellent prognosis irrespective of depth. In the absence of PORT, the 5-year disease-specific mortality was 10% with DOI ≥10 mm, 8% with DOI 5-10 mm, and 6% with DOI <5 mm (P = .169), yielding an absolute risk difference of only 4%.
The deterioration in prognosis with increasing DOI largely reflects an association with other adverse features. In the absence of these, depth alone should not be an indication for PORT outside a clinical trial.
我们旨在探讨浸润深度（DOI）是否应作为口腔小鳞状细胞癌（SCC）术后放疗（PORT）的独立指征。
回顾性分析了 1409 例大小≤4cm 的口腔 SCC 患者的 DOI（<5mm、5-<10mm、≥10mm）和疾病特异性生存（DSS）。这些患者均接受了 1990-2011 年间的多机构国际队列治疗。
在无其他不良因素（淋巴结转移；<5mm 的近距离 [<5mm]或受累边缘）的情况下，DOI 与 DSS 之间无相关性，无论深度如何，预后均良好。在未行 PORT 的情况下，DOI≥10mm 的患者 5 年疾病特异性死亡率为 10%，DOI 为 5-10mm 的患者为 8%，DOI<5mm 的患者为 6%（P=0.169），绝对风险差异仅为 4%。
随着 DOI 的增加，预后恶化在很大程度上反映了与其他不良特征的关联。在没有这些特征的情况下，单纯的深度不应该成为临床试验之外进行 PORT 的指征。
