Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Division of Biostatistics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, 16995, Gyeonggi-do, Republic of Korea.
Sci Rep. 2021 Sep 2;11(1):17562. doi: 10.1038/s41598-021-96827-1.
The aim of the present study was to examine the conditions, characteristics, and risk factors of level IIb lymph node metastases in oral squamous cell carcinoma and to formulate surgical criteria for level IIb lymph node dissection. We analyzed clinical and pathological records for 541 oral squamous carcinoma patients in relation to level IIb metastasis. Univariate and multivariate analyses were performed to detect risk factors for level IIb lymph node metastasis; a predictive model was built based on multivariate analysis and tested in a validation group. Univariate and multivariate analyses using the training group indicated that level IIa metastasis and Lymphovascular permeation (LVP) were two independent risk factors for level IIb lymph node metastasis. This model was built and tested in a validation group, the area under the curve being 0.697 (P < .0.001). The model's sensitivity was 66.7% and specificity was 77.4%. Nomogram incorporating validated variables was developed for level IIb metastasis prediction. Expected survival probabilites were analysed to specify significance of model's variable on patients' overall survival and recurrence. Level IIb dissection should be performed in patients with level IIa metastasis and LVP. However, thorough consideration of the oncologic safety of omitting level IIb dissection is compulsory.
本研究旨在探讨口腔鳞状细胞癌 IIb 级淋巴结转移的条件、特征和危险因素，并制定 IIb 级淋巴结清扫的手术标准。我们分析了 541 例口腔鳞状细胞癌患者的临床和病理记录，以了解 IIb 级转移的情况。采用单因素和多因素分析检测 IIb 级淋巴结转移的危险因素；基于多因素分析建立预测模型，并在验证组中进行测试。使用训练组进行的单因素和多因素分析表明，IIa 级转移和淋巴管浸润（LVP）是 IIb 级淋巴结转移的两个独立危险因素。该模型在验证组中进行了构建和测试，曲线下面积为 0.697（P < 0.001）。该模型的灵敏度为 66.7%，特异性为 77.4%。为 IIb 级转移预测建立了包含验证变量的列线图。分析预期生存概率以确定模型变量对患者总生存和复发的意义。对于存在 IIa 级转移和 LVP 的患者，应行 IIb 级淋巴结清扫术。然而，必须彻底考虑省略 IIb 级淋巴结清扫术的肿瘤安全性。
