对于 cN0 腺样囊性癌患者是否应行颈部解剖术？一项 REFCOR 倾向评分匹配研究。
Should a neck dissection be performed on patients with cN0 adenoid cystic carcinoma? A REFCOR propensity score matching study.
机构信息
Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la chine, 75020, Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif, France.
Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard Vaillant, 94805, Villejuif, France.
出版信息
Eur J Cancer. 2020 May;130:250-258. doi: 10.1016/j.ejca.2019.12.026. Epub 2020 Jan 30.
BACKGROUND
Patterns of nodal involvement in adenoid cystic carcinoma (ACC) of the head and neck have not been sufficiently assessed to guide a decision of prophylactic neck dissection (ND). The objective of this study is to analyse the influence of ND on event-free survival (EFS) for patients with cN0 ACC.
PATIENTS AND METHODS
A multicentre prospective study was conducted between 2009 and 2018. Patients presenting cN0 non-metastatic ACC on any site, and who received surgery on the tumour, were included. EFS was the main judgement criterion. A comparative survival analysis between the groups that received a ND versus those that did not was performed, using a propensity score. Analyses were carried out using the R software.
RESULTS
Between 2009 and 2018, 322 patients with cN0 ACC were included, out of which 58% were female. The average age was 53 years. Tumours were in minor salivary glands in 58% of cases, and 52% had T3/T4 stages. ND was performed on 46% of patients. Out of them, seven had histological lymph node invasion, out of which six had tumour infiltration in the mucosa of oral cavity. After propensity score, the median EFS for N0 patients with ND was 72 months (95% Confidence Interval (CI) [48-81]), compared to 73 months (95% CI [52-85]) for patients without ND (HR = 1.33; 95% CI [0.82-2.16]; p = 0.2).
CONCLUSION
ND of cN0 patients does not provide any benefit on EFS, which suggests that its application on such patients is not necessary.
背景
头颈部腺样囊性癌（ACC）的淋巴结受累模式尚未得到充分评估，无法为预防性颈部清扫术（ND）的决策提供指导。本研究的目的是分析 ND 对 cN0 ACC 患者无事件生存（EFS）的影响。
方法
本研究为 2009 年至 2018 年间开展的一项多中心前瞻性研究。纳入的患者为任何部位的 cN0 非转移性 ACC 且接受肿瘤手术治疗者。EFS 为主要判断标准。采用倾向评分对接受 ND 组和未接受 ND 组进行生存比较分析。分析采用 R 软件进行。
结果
2009 年至 2018 年间，共纳入 322 例 cN0 ACC 患者，其中 58%为女性，平均年龄为 53 岁。肿瘤位于小唾液腺者占 58%，T3/T4 期者占 52%。46%的患者接受了 ND，其中 7 例有组织学淋巴结侵犯，6 例有口腔黏膜肿瘤浸润。经倾向评分后，ND 组和未 ND 组的 cN0 患者的中位 EFS 分别为 72 个月（95%置信区间 [48-81]）和 73 个月（95%置信区间 [52-85]）（HR=1.33；95%置信区间 [0.82-2.16]；p=0.2）。
结论
对 cN0 患者进行 ND 并不能提高 EFS，这表明对该类患者进行 ND 并无必要。
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