Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Freiburg, Killianstr. 5, 79106, Freiburg, Germany.
Hals-Nasen-Ohrenklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany.
Eur Arch Otorhinolaryngol. 2020 Nov;277(11):3161-3168. doi: 10.1007/s00405-020-06043-2. Epub 2020 May 24.
Contralateral elective neck dissection (cEND) in oral and oropharyngeal squamous cell cancer (OC/OPC) is still a matter of debate. The current study analyzed the outcome in OC/OPC patients with/without cEND.
OC/OPC patients (n = 471) were diagnosed with contralateral N0 after CT/MRI-scan combined with neck ultrasound. Clinico-pathological features were analyzed using Chi-square/Fisher exact/Student's t test. Survival rates were calculated using Kaplan-Meier and log-rank test. Prognostic variables were evaluated by Cox regression. Primary/secondary endpoints were overall/recurrence-free survival (OS/RFS).
Pre-therapeutic imaging revealed a significantly over-staged N-status (p = 0.01), while occult contra-lateral N + was diagnosed in one patient only (0.4%). OC patients did not show differences in OS/RFS between the groups (ipsi- vs. bi-lateral). There was a strong tendency towards a better OS in OPC patients who underwent ipsi-lateral ND (p = 0.07). Cox-regression demonstrated that only tumor recurrence was associated with a fivefold increased risk of recurrence-associated death (p < 0.0001) that referred to a significant higher recurrence rate at primary tumor site (rT +) and increased distant metastatic outgrowth in OPC who underwent bi-lateral neck dissection (p = 0.03). While RFS of any cause (rT + /rN + /rM +) was significantly better in OPC with ipsi-lateral ND (p < 0.05), RFS of contralateral lymph node recurrence (rN2c) was comparable in both groups.
END of the contralateral cN0 neck is not correlated by an increased RFS or OS. Standard imaging techniques including CT/MRI scan and neck ultrasound warrant watchful waiting for neck dissection of the contralateral cN0 neck.
口腔和口咽鳞状细胞癌（OC/OPC）患者对侧选择性颈清扫术（cEND）仍然存在争议。本研究分析了 OC/OPC 患者行或不行 cEND 的结果。
对 471 例 CT/MRI 扫描联合颈部超声检查诊断为对侧 N0 的 OC/OPC 患者进行分析。采用卡方检验/Fisher 确切检验/Student t 检验分析临床病理特征。采用 Kaplan-Meier 法和对数秩检验计算生存率。采用 Cox 回归分析预后因素。主要/次要终点为总生存率/无复发生存率（OS/RFS）。
治疗前影像学检查显示 N 分期明显过度（p=0.01），但仅 1 例患者诊断为隐匿性对侧 N+（0.4%）。OC 患者组的 OS/RFS 两组间无差异（同侧 vs. 双侧）。接受同侧颈清扫术的 OPC 患者 OS 有更好的趋势（p=0.07）。Cox 回归分析表明，只有肿瘤复发与复发相关死亡风险增加 5 倍相关（p<0.0001），这意味着同侧颈清扫术的 OPC 患者原发肿瘤部位（rT+）的复发率更高，远处转移的发生率也更高（p=0.03）。虽然同侧颈清扫术的 OPC 患者任何原因的 RFS（rT+ / rN+ / rM+）均显著更好（p<0.05），但双侧颈清扫术组的对侧淋巴结复发（rN2c）RFS 无差异。
对侧 cN0 颈 END 与 RFS 或 OS 无相关性。包括 CT/MRI 扫描在内的标准影像学技术支持对 cN0 颈行观察等待。
