Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
BMC Oral Health. 2021 Jan 13;21(1):29. doi: 10.1186/s12903-021-01389-3.
High quality lymph node (LN) yield could increase survival, however strategies to improve LN yield have been seldom reported. This study aimed to assess the multiple-step action to promote quality of neck dissection in oral cancer.
A total of 400 patients with oral cancer who underwent primary tumor resection and neck dissection, including elective and radical neck dissection, were recruited after propensity score matching by clinical T and N categories between January 2009 and September 2018. Patients were treated by two independent departments in our institute. A multiple-step action was initiated in October 2015 in one department, and another department was as a control group. The impact of multiple-step action on LN yield and regional recurrence were analyzed using multivariate analysis and difference-in-differences (DID) linear regression analysis.
The mean patient age was 55.2 + 11.1 years, and 92% were male. A total of 180 (45%) patients had T3-4 disease, and 129 (32%) patients had N2-3 disease. The multivariate linear regression and DID analyses revealed that multiple-step action had a positive effect on LN yield. A net improvement of LN yield with a coefficient of 13.78 (p < 0.001) after launching multiple-step action (since October 2015) was observed. A borderline protective effect of multiple-step action for cN0 patients with a reduced regional recurrence rate of 11.6% (p = 0.072) through DID analysis was noted.
Multiple-step action was associated with increased LN yield and decreased regional recurrence in patients with oral cancer. The observed activity may promote surgeons to improve the quality of neck dissections, is feasible, and could be applied to a widespread patient population.
高质量的淋巴结（LN）检出率可提高生存率，但提高 LN 检出率的策略鲜有报道。本研究旨在评估促进口腔癌颈部清扫术质量的多步骤行动。
共纳入 400 例于 2009 年 1 月至 2018 年 9 月间按临床 T 和 N 分期进行倾向评分匹配的口腔癌患者，行原发灶切除术和颈部清扫术，包括选择性和根治性颈部清扫术。患者由我院两个独立科室进行治疗。2015 年 10 月，一个科室开始采取多步骤行动，另一个科室作为对照组。采用多元分析和差异中的差异（ DID ）线性回归分析，评估多步骤行动对 LN 检出率和区域复发的影响。
患者的平均年龄为 55.2±11.1 岁，92%为男性。180 例（45%）患者为 T3-4 期，129 例（32%）患者为 N2-3 期。多元线性回归和 DID 分析表明，多步骤行动对 LN 检出率有积极影响。自 2015 年 10 月开展多步骤行动以来，LN 检出率有 13.78（p<0.001）的净改善。通过 DID 分析，多步骤行动对 cN0 患者有边缘保护作用，可降低 11.6%的区域复发率（p=0.072）。
多步骤行动与口腔癌患者的 LN 检出率增加和区域复发减少相关。所观察到的活动可能促进外科医生提高颈部清扫术的质量，具有可行性，并可应用于广泛的患者人群。
