Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia.
Department of Cancer Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia.
Oral Oncol. 2021 Apr;115:105190. doi: 10.1016/j.oraloncology.2021.105190. Epub 2021 Feb 11.
The importance of treating the bilateral neck in lateralized small oral cavity squamous cell carcinoma (OCC) is unclear. We sought to define the incidence and predictors of contralateral neck failure (CLF) in patients who underwent unilateral treatment.
We performed a multi-institutional retrospective study of patients with pathologic T1-T2 (AJCC 7th edition) OCC with clinically node negative contralateral neck who underwent unilateral treatment with primary surgical resection ± adjuvant radiotherapy between 2005 and 2015. Incidence of CLF was estimated using the cumulative incidence method. Clinicopathological factors were analyzed by univariate (UVA) and multivariate analysis (MVA) for possible association with CLF. Kaplan-Meier analysis was used to estimate overall survival (OS).
176 patients were evaluated with a median of 65.9 months of follow-up. Predominant pathologic T-stage was T1 (68%), 8.5% of patients were N1, 2.8% were N2b. Adjuvant radiotherapy was delivered to 17% of patients. 5-year incidence of CLF was 4.3% (95% CI 1.2-7.4%). Depth of invasion (DOI) > 10 mm and positive ipsilateral neck node were significant predictors for CLF on UVA. DOI > 10 mm remained significant on MVA (HR = 6.7, 95% CI 1.4-32.3, p = 0.02). The 2- and 5-year OS was 90.6% (95% CI 86.2-95.0%) and 80.6% (95% CI 74.5-86.8%), respectively.
Observation of the clinically node negative contralateral neck in small lateralized OCC can be a suitable management approach in well selected patients, however caution should be applied when DOI upstages small but deeply invasive tumors to T3 on 8th edition AJCC staging.
在侧方小口腔鳞状细胞癌（OCC）中，双侧颈部治疗的重要性尚不清楚。我们旨在确定接受单侧治疗的患者中对侧颈部失败（CLF）的发生率和预测因素。
我们对 2005 年至 2015 年间接受单侧手术切除±辅助放疗的临床阴性对侧颈部病理性 T1-T2（第 7 版 AJCC）OCC 且伴有对侧颈部临床阴性的患者进行了多机构回顾性研究。使用累积发生率法估计 CLF 的发生率。通过单变量（UVA）和多变量分析（MVA）分析临床病理因素与 CLF 的可能关联。采用 Kaplan-Meier 分析估计总生存率（OS）。
176 例患者接受了中位随访时间为 65.9 个月的评估。主要的病理 T 分期为 T1（68%），8.5%的患者为 N1，2.8%为 N2b。17%的患者接受了辅助放疗。5 年 CLF 发生率为 4.3%（95%CI 1.2-7.4%）。UVA 分析显示，浸润深度（DOI）>10mm 和同侧颈部阳性淋巴结是 CLF 的显著预测因素。MVA 分析显示，DOI>10mm 仍然是 CLF 的显著预测因素（HR=6.7，95%CI 1.4-32.3，p=0.02）。2 年和 5 年的 OS 分别为 90.6%（95%CI 86.2-95.0%）和 80.6%（95%CI 74.5-86.8%）。
在选择合适的患者中，对小侧方 OCC 临床阴性的对侧颈部进行观察可以是一种合适的管理方法，但是当第 8 版 AJCC 分期将小但深部浸润性肿瘤升级为 T3 时，应谨慎对待 DOI。
