School of Dentistry, China Medical University, Taichung, Taiwan; Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Oral Oncol. 2021 Mar;114:105146. doi: 10.1016/j.oraloncology.2020.105146. Epub 2021 Jan 16.
The evaluation of neck lymph node metastasis is critical for predicting survival after head and neck cancer treatment. However, traditional pathological N staging does not completely correlate with survival; the total number of lymph nodes resected during surgery affects staging, and a minimal number of nodes must be resected to achieve a superior outcome. Thus, the prognostic abilities of various lymph node staging systems for oral cavity squamous cell carcinoma (OSCC)-positive lymph nodes were compared.
Data for 639 patients with OSCC-positive nodes who were treated and monitored at the Changhua Christian Hospital were retrospectively analyzed. The different N staging systems were compared to evaluate their disease-free survival (DFS) predictability.
The areas under the receiver operating characteristic curve were as follows: 0.551 for the traditional American Joint Committee on Cancer (AJCC) N staging, 0.60 for lymph node density (LND), 0.596 for log odds of positive lymph nodes (LODDS), and 0.597 for the number of metastatic lymph nodes (nmLN). The LND, LODDS, and nmLN systems could predict DFS better than AJCC N staging. Multivariable analysis for DFS revealed that extranodal spread, level IV or V positive nodes, and tumor invasion deeper than 13 mm were independent prognostic factors in these four models. LND and LODDS predicted DFS better than pathological N staging.
LND and LODDS staging predicted DFS better than AJCC N staging for OSCC-positive nodes. In the future, the prognostic ability of AJCC staging may be strengthened by LND or LODDS staging.
评估颈部淋巴结转移对于预测头颈部癌症治疗后的生存情况至关重要。然而，传统的病理 N 分期与生存并不完全相关；手术过程中切除的淋巴结总数会影响分期，并且必须切除一定数量的淋巴结才能获得更好的结果。因此，比较了各种用于口腔鳞状细胞癌（OSCC）阳性淋巴结的淋巴结分期系统的预后能力。
回顾性分析了在彰化基督教医院接受治疗和监测的 639 例 OSCC 阳性淋巴结患者的数据。比较了不同的 N 分期系统，以评估其无病生存率（DFS）的预测能力。
受试者工作特征曲线下面积如下：传统的美国癌症联合委员会（AJCC）N 分期为 0.551，淋巴结密度（LND）为 0.60，阳性淋巴结对数优势比（LODDS）为 0.596，转移淋巴结数量（nmLN）为 0.597。LND、LODDS 和 nmLN 系统比 AJCC N 分期能更好地预测 DFS。DFS 的多变量分析显示，在这四个模型中，淋巴结外扩散、IV 或 V 水平阳性淋巴结和肿瘤侵犯深度超过 13 毫米是独立的预后因素。LND 和 LODDS 预测 DFS 优于病理 N 分期。
对于 OSCC 阳性淋巴结，LND 和 LODDS 分期比 AJCC N 分期更能预测 DFS。在未来，LND 或 LODDS 分期可能会增强 AJCC 分期的预后能力。
