Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
Laryngoscope. 2020 Aug;130(8):1947-1953. doi: 10.1002/lary.28620. Epub 2020 May 13.
OBJECTIVES/HYPOTHESIS: Our study aimed to review the impact of preoperative radiotherapy (RT) and other factors on the lymph node count of neck dissection (ND) specimens from patients with head and neck cancer (HNC). A retrospective study was conducted on all patients with head and neck cancers who had undergone NDs in Singapore General Hospital between 1992 and 2013.
Retrospective study.
Patients were categorized into two groups: patients treated with RT with or without chemotherapy before ND and patients who had undergone ND surgery without previous history of RT. The primary endpoint for this study would be the lymph node count from ND.
The study cohort consists of 1,024 NDs on 829 patients. There were 597 (58.3%) radical/modified radical NDs involving levels I-V. Within this group, 75 (12.6%) NDs had preoperative RT. Preoperative RT and age were found to significantly reduce nodal yield in both univariate and multivariate analysis in the radical/modified radical ND subgroup. In our multivariate analysis, preoperative RT was shown to decrease the nodal yield by 7.464 (P = .0002, 95% confidence interval [CI]: -11.35 to -3.58). Advanced age independently decreases nodal yield, even after accounting for the effect of RT (P = .0002, 95% CI: -0.27 to -0.08). In addition, preoperative RT has a more pronounced effect in reducing lymph node count in the older age group.
Preoperative RT and advanced age are independent and synergistic factors that reduce nodal count from NDs in patients with head and neck cancers.
4 Laryngoscope, 130: 1947-1953, 2020.
目的/假设：本研究旨在回顾术前放疗（RT）和其他因素对头颈癌（HNC）患者颈部清扫术（ND）标本淋巴结计数的影响。对 1992 年至 2013 年间在新加坡综合医院接受 ND 的所有头颈部癌症患者进行了一项回顾性研究。
回顾性研究。
患者分为两组：接受 RT 加或不加化疗的患者和未接受过 RT 的 ND 手术的患者。本研究的主要终点是 ND 的淋巴结计数。
研究队列包括 829 例患者的 1024 次 ND。有 597 例（58.3%）根治性/改良根治性 ND 涉及 I-V 水平。在这一组中，有 75 例（12.6%）ND 术前有 RT。在单变量和多变量分析中，术前 RT 均显著降低根治性/改良根治性 ND 亚组的淋巴结产量。在多变量分析中，术前 RT 显示出的淋巴结产量减少了 7.464（P =.0002，95%置信区间[CI]：-11.35 至-3.58）。即使考虑到 RT 的影响，年龄较大也会独立降低淋巴结产量（P =.0002，95%CI：-0.27 至-0.08）。此外，术前 RT 在减少老年患者的淋巴结计数方面具有更显著的效果。
术前 RT 和年龄较大是独立的协同因素，可减少头颈部癌症患者 ND 的淋巴结计数。
4 Laryngoscope, 130: 1947-1953, 2020.
