Department of radiation oncology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan.
Department of radiation oncology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan.
Auris Nasus Larynx. 2021 Oct;48(5):991-998. doi: 10.1016/j.anl.2021.01.016. Epub 2021 Jan 30.
To evaluate the contralateral lymph node recurrence rate (clLNRR) of stage IVA to IVB well-lateralized oral cavity cancer. To evaluate the risk factors of clLNRR.
Pathologic stage IVA-B squamous cell carcinoma of oral cavity, originating from buccal mucosa, gingiva, or retromolar trigone were retrospectively recruited. Those who did not receive definitive surgery, with previous cancer history, or with contralateral nodal metastasis at diagnosis were excluded.
From 2010 to 2017, 120 cases were enrolled, including 103 pT4 and 38 pN2. Thirty-one patients underwent contralateral neck dissection, and 18 had contralateral elective nodal irradiation. After median follow up of 35.1 months, the 3-year clLNRR was 15.7% (95% CI: 8.8 - 22.6%) as first event and was 17.1% (95% CI: 9.8 - 24.4%) for overall recurrences. The 3-year disease-free survival and overall survival were 52.8% and 63.1%, respectively. In multivariate analysis, positive nodal metastasis, gingival origin, and perineural invasion were associated with significantly higher clLNRR. Nodal metastasis was the strongest prognostic factor for clLNRR (pN1, HR: 17.1, p = 0.010; pN2, HR: 16.7, p = 0.004, comparing to pN0). The 3-year clLNRR were 2.9% for pN0 (n = 71, 95% CI: 0 - 6.8%), 37.7% for pN1 (n = 11, 95% CI: 8.3 - 67.1%), and 38.4% for pN2 (n = 38, 95% CI: 19.2 - 57.6%). Advanced T classification, elective contralateral neck dissection, and contralateral nodal irradiation did not have significant impact on clLNRR.
Positive homolateral nodal metastasis, gingival origin, and perineural invasion were risk factors correlated with significantly higher clLNRR. For patient without nodal metastasis, the clLNRR was low and elective contralateral neck management might be safely omitted. For patients with homolateral nodal disease, the contralateral nodal recurrence was not unusual. The optimal treatment for these high risk patients warrant further research.
评估 IVA 期至 IVB 期局限性口腔癌的对侧淋巴结复发率（clLNRR）。评估 clLNRR 的危险因素。
回顾性招募来自颊黏膜、牙龈或磨牙后三角的病理分期为 IVA-B 期的口腔鳞状细胞癌患者。排除未接受确定性手术、有既往癌症病史或诊断时对侧淋巴结转移的患者。
2010 年至 2017 年，共纳入 120 例患者，其中 103 例为 pT4，38 例为 pN2。31 例患者接受了对侧颈部清扫术，18 例患者接受了对侧选择性淋巴结照射。中位随访 35.1 个月后，3 年 clLNRR 为 15.7%（95%CI：8.8-22.6%），作为首发事件，总复发率为 17.1%（95%CI：9.8-24.4%）。3 年无病生存率和总生存率分别为 52.8%和 63.1%。多因素分析显示，淋巴结阳性转移、牙龈起源和神经周围侵犯与更高的 clLNRR 显著相关。淋巴结转移是 clLNRR 的最强预后因素（pN1，HR：17.1，p=0.010；pN2，HR：16.7，p=0.004，与 pN0 相比）。pN0 患者的 3 年 clLNRR 为 2.9%（n=71，95%CI：0-6.8%），pN1 患者为 37.7%（n=11，95%CI：8.3-67.1%），pN2 患者为 38.4%（n=38，95%CI：19.2-57.6%）。高级 T 分类、选择性对侧颈部清扫术和对侧淋巴结照射对 clLNRR 无显著影响。
同侧淋巴结阳性转移、牙龈起源和神经周围侵犯是与 clLNRR 显著相关的危险因素。对于无淋巴结转移的患者，clLNRR 较低，选择性对侧颈部管理可能安全省略。对于同侧淋巴结疾病的患者，对侧淋巴结复发并不罕见。这些高危患者的最佳治疗方法需要进一步研究。
