Radiation Oncology Department, Centre Léon Bérard, Lyon, France.
Pathology Department, Centre Léon Bérard, Lyon, France.
Radiother Oncol. 2021 Apr;157:122-129. doi: 10.1016/j.radonc.2021.01.028. Epub 2021 Feb 3.
In oropharyngeal squamous cell carcinoma (OP-SCC), the prevalence and distribution of clinical and pathological lymph node metastasis in the neck have been extensively reported. It served as the basis for consensus recommendations on the selection of the lymph node levels in the neck requiring a treatment. The objective of the study is to compare the prevalence and distribution of neck node metastases in HPV+ and HPV- OP-SCC from a large series of patients with OP-SCC who underwent a cervical lymph-node dissection (LND) as part of their treatment.
The study concentrated on OP-SCC patients treated by various neck node dissection (LND) procedures from January 2014 to December 2018 in 3 French institutions. Patients with prior head and neck cancer, prior neck surgery, the use of induction chemotherapy, or patients with carcinoma of unknown primary were excluded. HPV-status was assessed by p16 immunohistochemistry. For each patient, the clinical and the pathological nodal status, as well as the distribution of the positive nodes in each neck level (from Ia to V) were reported.
Two-hundred and sixty-three patients were included (126 p16-negative (p16-), and 137 p16-positive (p16+). The rate of clinical positive node (cN+) reached 54% and 88.3% in the p16- and p16+ groups, respectively (p < 0.001); the corresponding rate of pathological positive node (pN+) reached 61.9% and 91.2%, respectively (p < 0.001). Regarding the clinical lymph node distribution, in p16+ patients, more positive nodes were observed in the ipsilateral level IV (p = 0.003), and less positive nodes were observed in the contralateral levels III and IV (p = 0.003 and p = 0.045, respectively). Regarding the pathologic lymph node distribution in the ipsilateral neck, in the cN0 patients, no significant difference was observed between p16- and p16+ patients (p = 0.33 to 1); in the cN+ patients, the nodes were distributed in levels Ib, II, III, IV and V without differences between the p16- and the p16+ patients. In the contralateral neck of p16- patients, nodes metastases were mainly observed in levels II, III and IV, whereas for the p16+ patients, positive nodes were only observed in level II (p = 0.03).
This study demonstrated the higher prevalence of cN+ and pN+ in p16+ OP-SCC patients, but without meaningful difference in the distribution of the lymph node drainage between p16- and p16+ OP-SCC. It indicates that no difference should be made between p16- and p16+ patients regarding the extend of neck treatment.
在口咽鳞状细胞癌（OP-SCC）中，颈部临床和病理淋巴结转移的发生率和分布已有广泛报道。这为颈部淋巴结水平治疗的选择提供了共识建议的基础。本研究的目的是比较 HPV+和 HPV-OP-SCC 患者中颈部淋巴结转移的发生率和分布，这些患者均为接受颈部淋巴结清扫术（LND）作为治疗一部分的 OP-SCC 大型系列患者。
本研究集中于 2014 年 1 月至 2018 年 12 月期间，3 家法国机构接受各种颈部淋巴结清扫术（LND）的 OP-SCC 患者。排除了有头颈部癌症病史、颈部手术史、诱导化疗史或不明原发灶癌的患者。HPV 状态通过 p16 免疫组化评估。对于每位患者，报告了临床和病理淋巴结状态，以及每个颈部水平（从 Ia 到 V）阳性淋巴结的分布。
共纳入 263 名患者（126 名 p16-阴性（p16-），137 名 p16-阳性（p16+）。p16-和 p16+组的临床阳性淋巴结（cN+）的发生率分别为 54%和 88.3%（p<0.001）；相应的病理阳性淋巴结（pN+）的发生率分别为 61.9%和 91.2%（p<0.001）。关于临床淋巴结分布，在 p16+患者中，同侧 IV 水平的阳性淋巴结更多（p=0.003），对侧 III 和 IV 水平的阳性淋巴结更少（p=0.003 和 p=0.045）。关于同侧颈部的病理淋巴结分布，在 cN0 患者中，p16-和 p16+患者之间无显著差异（p=0.33 至 1）；在 cN+患者中，淋巴结分布在 Ib、II、III、IV 和 V 水平，p16-和 p16+患者之间无差异。在 p16-患者的对侧颈部中，淋巴结转移主要发生在 II、III 和 IV 水平，而在 p16+患者中，仅在 II 水平观察到阳性淋巴结（p=0.03）。
本研究表明 p16+ OP-SCC 患者的 cN+和 pN+发生率更高，但 p16-和 p16+ OP-SCC 之间的淋巴结引流分布无显著差异。这表明 p16-和 p16+患者在颈部治疗的范围上不应有区别。
