T3/T4 cN0 鼻窦鳞状细胞癌的选择性颈部清扫术。
Elective neck dissection for T3/T4 cN0 sinonasal squamous cell carcinoma.
作者信息
Crawford Kayva L, Jafari Aria, Qualliotine Jesse R, Stuart Emelia, DeConde Adam S, Califano Joseph A, Orosco Ryan K
机构信息
Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA.
Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
出版信息
Head Neck. 2020 Dec;42(12):3655-3662. doi: 10.1002/hed.26418. Epub 2020 Aug 24.
BACKGROUND
In locally advanced sinonasal squamous cell carcinoma (SNSCC), management of the clinically node-negative (cN0) neck is variable and elective neck dissection (END) remains controversial.
METHODS
Patients with surgically treated T3/T4 cN0 M0 SNSCC were identified using the NCDB. Overall survival (OS) was assessed by Cox proportional hazard analysis in propensity score-matched cohorts. Factors associated with END were evaluated with logistic regression.
RESULTS
Two hundred twenty patients underwent END (19.6%). END did not correlated with OS in propensity score-matched cohorts (HR 0.971, 95% CI 0.677-1.392), a maxillary sinus tumor subgroup (HR 1.089, 95% CI 0.742-1.599), or by radiation status [radiation: (HR 0.802, 95% CI 0.584-1.102); no radiation: (HR 0.852, 95% CI 0.502-1.445)]. The occult metastasis rate in the END cohort was 12.7%.
CONCLUSION
END did not significantly improve OS in this study. Further information on disease-free survival is necessary to determine its role in advanced-stage SNSCC.
背景
在局部晚期鼻窦鳞状细胞癌（SNSCC）中，对临床颈部淋巴结阴性（cN0）患者的颈部处理方式各异，选择性颈部清扫术（END）仍存在争议。
方法
利用国家癌症数据库（NCDB）确定接受手术治疗的T3/T4 cN0 M0 SNSCC患者。在倾向评分匹配队列中，通过Cox比例风险分析评估总生存期（OS）。采用逻辑回归评估与END相关的因素。
结果
220例患者接受了END（19.6%）。在倾向评分匹配队列中，END与OS无关（风险比[HR] 0.971，95%置信区间[CI] 0.677 - 1.392），在上颌窦肿瘤亚组中也无关（HR 1.089，95% CI 0.742 - 1.599），且与放疗状态无关[放疗：（HR 0.802，95% CI 0.584 - 1.102）；未放疗：（HR 0.852，95% CI 0.502 - 1.445）]。END队列中的隐匿转移率为12.7%。
结论
在本研究中，END未显著改善OS。需要更多关于无病生存期的信息来确定其在晚期SNSCC中的作用。
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