Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, California, USA.
School of Medicine, University of California-San Francisco, California, USA.
Otolaryngol Head Neck Surg. 2021 Mar;164(3):624-630. doi: 10.1177/0194599820951473. Epub 2020 Sep 8.
For human papilloma virus-associated oropharynx squamous cell carcinoma (HPV+ OPSCC), we evaluated the distribution of neck-level lymph node (LN) metastasis, based on postsurgical histopathology, and the incidence of and risk factors for occult LN metastases, as these patterns need clarification for this newer cancer subset.
Retrospective cohort study.
National Cancer Database (NCDB).
We analyzed 2358 patients in the NCDB with HPV+ OPSCC who underwent neck dissection (ND) from 2010 to 2015. Incidence and distribution of LN metastases were calculated for neck levels I to V. Variables associated with occult LN metastasis were assessed by multivariate logistic regression.
In therapeutic NDs (n = 1935), the following proportions of positive LNs were found: level I, 9.0% (n = 175); level II, 81.0% (n = 1568); level III, 29.6% (n = 573); level IV, 11.9% (n = 230); and level V, 4.9% (n = 95). In elective NDs (n = 423), occult-positive LNs were found in 35.8% (n = 152), with the following proportions by level: level I, 3.3% (n = 14); level II, 26.9% (n = 114); level III, 8.7% (n = 37); level IV, 4.0% (n = 17); and level V, 0.2% (n = 1). The presence of occult LNs was independently associated with a Charlson-Deyo score of 1 (odds ratio, 2.26; 95% CI, 1.18-4.31; = .014) and lymphovascular invasion (odds ratio, 5.91; 95% CI, 3.21-11.18; < .001). Occult LN metastases were not significantly associated with pT classification, primary site, or number of LNs resected.
For HPV+ OPSCC, occult nodal disease is common. Therapeutic NDs should encompass at least levels II, III, and IV and possibly I, whereas elective NDs could possibly encompass levels II and III.
对于人乳头瘤病毒相关的口咽鳞状细胞癌（HPV+ OPSCC），我们根据术后组织病理学评估颈淋巴结（LN）转移的分布情况，并评估隐匿性 LN 转移的发生率和危险因素，因为这些模式需要明确，以便对这个较新的癌症亚群进行研究。
回顾性队列研究。
国家癌症数据库（NCDB）。
我们分析了 2010 年至 2015 年期间在 NCDB 中接受颈清扫术（ND）的 2358 例 HPV+ OPSCC 患者，计算了颈 I 至 V 水平的 LN 转移的发生率和分布情况。通过多变量逻辑回归评估与隐匿性 LN 转移相关的变量。
在治疗性 ND（n=1935）中，阳性 LN 的比例如下：I 水平，9.0%（n=175）；II 水平，81.0%（n=1568）；III 水平，29.6%（n=573）；IV 水平，11.9%（n=230）；V 水平，4.9%（n=95）。在选择性 ND（n=423）中，隐匿性阳性 LN 为 35.8%（n=152），按水平的比例如下：I 水平，3.3%（n=14）；II 水平，26.9%（n=114）；III 水平，8.7%（n=37）；IV 水平，4.0%（n=17）；V 水平，0.2%（n=1）。隐匿性 LN 的存在与 Charlson-Deyo 评分 1（优势比，2.26；95%置信区间，1.18-4.31；=0.014）和血管淋巴管侵犯（优势比，5.91；95%置信区间，3.21-11.18；<0.001）独立相关。隐匿性 LN 转移与 pT 分类、原发部位或切除的 LN 数量无显著相关性。
对于 HPV+ OPSCC，隐匿性淋巴结疾病很常见。治疗性 ND 应至少包括 II、III 和 IV 水平，可能还包括 I 水平，而选择性 ND 可能仅包括 II 和 III 水平。
4 级。
