Aaboubout Yassine, van der Toom Quincy M, de Ridder Maria A J, De Herdt Maria J, van der Steen Berdine, van Lanschot Cornelia G F, Barroso Elisa M, Nunes Soares Maria R, Ten Hove Ivo, Mast Hetty, Smits Roeland W H, Sewnaik Aniel, Monserez Dominiek A, Keereweer Stijn, Caspers Peter J, Baatenburg de Jong Robert J, Bakker Schut Tom C, Puppels Gerwin J, Hardillo José A, Koljenović Senada
Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Front Oncol. 2021 Mar 12;11:628320. doi: 10.3389/fonc.2021.628320. eCollection 2021.
The depth of invasion (DOI) is considered an independent risk factor for occult lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). It is used to decide whether an elective neck dissection (END) is indicated in the case of a clinically negative neck for early stage carcinoma (pT1/pT2). However, there is no consensus on the cut-off value of the DOI for performing an END. The aim of this study was to determine a cut-off value for clinical decision making on END, by assessing the association of the DOI and the risk of occult lymph node metastasis in early OCSCC.
A retrospective cohort study was conducted at the Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Patients surgically treated for pT1/pT2 OCSCC between 2006 and 2012 were included. For all cases, the DOI was measured according to the 8 edition of the American Joint Committee on Cancer guideline. Patient characteristics, tumor characteristics (pTN, differentiation grade, perineural invasion, and lymphovascular invasion), treatment modality (END or watchful waiting), and 5-year follow-up (local recurrence, regional recurrence, and distant metastasis) were obtained from patient files.
A total of 222 patients were included, 117 pT1 and 105 pT2. Occult lymph node metastasis was found in 39 of the 166 patients who received END. Univariate logistic regression analysis showed DOI to be a significant predictor for occult lymph node metastasis (odds ratio (OR) = 1.3 per mm DOI; 95% CI: 1.1-1.5, = 0.001). At a DOI of 4.3 mm the risk of occult lymph node metastasis was >20% (all subsites combined).
The DOI is a significant predictor for occult lymph node metastasis in early stage oral carcinoma. A NPV of 81% was found at a DOI cut-off value of 4 mm. Therefore, an END should be performed if the DOI is >4 mm.
浸润深度（DOI）被认为是口腔鳞状细胞癌（OCSCC）隐匿性淋巴结转移的独立危险因素。它用于决定早期癌（pT1/pT2）颈部临床阴性时是否需要进行择区颈清扫术（END）。然而，关于进行END的DOI临界值尚无共识。本研究的目的是通过评估DOI与早期OCSCC隐匿性淋巴结转移风险的关联，确定用于END临床决策的临界值。
在荷兰鹿特丹伊拉斯姆斯医学中心大学医学中心进行了一项回顾性队列研究。纳入2006年至2012年间接受手术治疗的pT1/pT2 OCSCC患者。对于所有病例，根据美国癌症联合委员会第8版指南测量DOI。从患者病历中获取患者特征、肿瘤特征（pTN、分化程度、神经周围浸润和淋巴管浸润）、治疗方式（END或观察等待）以及5年随访情况（局部复发、区域复发和远处转移）。
共纳入222例患者，其中pT1 117例，pT2 105例。在接受END的166例患者中，有39例发现隐匿性淋巴结转移。单因素逻辑回归分析显示DOI是隐匿性淋巴结转移的显著预测因素（优势比（OR）=每毫米DOI为1.3；95%置信区间：1.1 - 1.5，P = 0.001）。当DOI为4.3毫米时，隐匿性淋巴结转移风险>20%（所有亚部位合并）。
DOI是早期口腔癌隐匿性淋巴结转移的显著预测因素。在DOI临界值为4毫米时，阴性预测值为81%。因此，如果DOI>4毫米，应进行END。
