University of Texas Southwestern Medical School, Dallas, Texas, U.S.A.
Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Laryngoscope. 2021 Jul;131(7):1516-1521. doi: 10.1002/lary.29353. Epub 2021 Jan 4.
OBJECTIVE/HYPOTHESIS: Decreased lymph node count (LNC) from neck dissection (ND) for mucosal head and neck squamous cell carcinoma (HNSCC) patients is correlated with decreased survival. Advanced age and low BMI due to undernutrition from dysphagia from advanced T-stage tumors are common in patients with HNSCC. We studied the relationship between these two well-described causes for immune dysfunction and LNC in patients undergoing neck dissection.
We conducted a retrospective review at a single tertiary care institution of patients with HNSCC that underwent neck dissection from 2006 to 2017.
Stepwise linear and logistic regression analyses were performed on 247 subjects to identify independent significant factors associated with 1) the LNC per neck level dissected; 2) advanced T-stage. One-way ANOVA was utilized to demonstrate differences between the p16 positive and negative subgroups.
Low BMI (<23 vs. ≥23) (P = .03), extra nodal extension (ENE) (P = .0178), and advanced age (P = .005) were associated with decreased LNC per neck level dissected on multivariable analysis. Higher T-stage (P = .0005) was correlated with low BMI (<23) after controlling for the effects of tobacco, smoking, sex, ECE, and p16 status. p16+ patients, on average had higher BMI, were younger and produced a higher nodal yield (P < .0001, .007, and .035).
Patient intrinsic factors known to correlate with decreased immune function and worse outcomes, including p16 negative status, advanced age, and low BMI from undernutrition and ENE are associated with low nodal yield in neck dissections. LNC may be a metric for anti-tumor immune function that correlates with prognosis and T-stage.
3 Laryngoscope, 131:1516-1521, 2021.
目的/假设：头颈部黏膜鳞状细胞癌（HNSCC）患者颈部清扫术（ND）的淋巴结计数（LNC）减少与生存率降低相关。由于晚期 T 期肿瘤引起的吞咽困难导致营养不良，HNSCC 患者中常见高龄和低 BMI。我们研究了这两种公认的导致免疫功能障碍的原因与接受颈部清扫术的患者 LNC 之间的关系。
我们对一家三级医疗中心 2006 年至 2017 年间接受颈部清扫术的 HNSCC 患者进行了回顾性研究。
对 247 例患者进行逐步线性和逻辑回归分析，以确定与 1）每个切除的颈部水平的 LNC 相关的独立显著因素；2）高级 T 期相关的独立显著因素。采用单因素方差分析比较 p16 阳性和阴性亚组之间的差异。
低 BMI（<23 与≥23）（P =.03）、淋巴结外扩展（ENE）（P =.0178）和高龄（P =.005）与多变量分析中每个切除的颈部水平的 LNC 减少相关。在控制烟草、吸烟、性别、ENE 和 p16 状态的影响后，较高的 T 期（P =.0005）与低 BMI（<23）相关。p16+患者平均 BMI 较高，年龄较小，淋巴结产量较高（P <.0001，P =.007 和 P =.035）。
与免疫功能下降和预后不良相关的患者内在因素，包括 p16 阴性状态、高龄、营养不良导致的低 BMI 和 ENE，与颈部清扫术的低淋巴结产量相关。LNC 可能是一种与预后和 T 期相关的抗肿瘤免疫功能的指标。
3 级喉镜，131：1516-1521，2021。
