Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou, Zhejiang, China; Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou, Zhejiang, China.
J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e484-e488. doi: 10.1016/j.jormas.2022.05.001. Epub 2022 May 6.
Head and neck squamous cell carcinoma (HNSCC) is characterized by high frequency of early cervical lymph node metastases (LNMs), resulting in poor survival of patients. However, cervical LNMs are difficult to detect, which makes the decision-making of which patients should undergo neck dissection surgery challenging for surgeons. This study aimed to analyze the clinicopathological risk factors associated with cervical LNM and determine the indications for neck dissection in HNSCC patients.
The medical records of patients diagnosed with HNSCC who were treated at our hospital between January 2010 and June 2020 were retrospectively reviewed. A database of their clinicopathological data, including sex, age at diagnosis, primary tumor regions, tumor size, and grade, was constructed. The associations of these clinicopathological features with cervical LNM were analyzed using univariate and multivariate logistic regression analyses. The TCGA database were used to externally validate the risk factors.
Overall, 531 patients with HNSCC were included; 38.6% had confirmed pathological cervical LNM. Univariate and multivariate analyses identified that tumor size and grade were independent risk factors associated with LNM (odds ratio = 1.338, 95% CI: 1.015-1.767, p < 0.05; odds ratio = 1.936, 95% CI: 1.46-2.587, p < 0.0001, respectively). The significant positive associations of tumor size and grade with LNM were externally validated in the TCGA datasets.
HNSCC patients with large tumor size or poor tumor differentiation degree were at high risk of lymph node metastasis and were recommended to undergo neck dissection.
头颈部鳞状细胞癌（HNSCC）的特点是早期颈部淋巴结转移（LNM）的频率较高，导致患者的生存率较差。然而，颈部 LNM 很难检测，这使得外科医生在决定哪些患者应行颈清扫术方面具有挑战性。本研究旨在分析与颈部 LNM 相关的临床病理危险因素，并确定 HNSCC 患者行颈清扫术的适应证。
回顾性分析 2010 年 1 月至 2020 年 6 月在我院治疗的 HNSCC 患者的病历。构建了包括性别、诊断时年龄、原发肿瘤部位、肿瘤大小和分级在内的临床病理数据数据库。使用单因素和多因素逻辑回归分析这些临床病理特征与颈部 LNM 的相关性。使用 TCGA 数据库对外验证危险因素。
共纳入 531 例 HNSCC 患者，38.6%的患者经病理证实存在颈部 LNM。单因素和多因素分析均发现肿瘤大小和分级是与 LNM 相关的独立危险因素（比值比=1.338，95%可信区间：1.015-1.767，p<0.05；比值比=1.936，95%可信区间：1.46-2.587，p<0.0001）。肿瘤大小和分级与 LNM 的显著正相关在 TCGA 数据集中得到了外部验证。
肿瘤体积较大或分化程度较差的 HNSCC 患者发生淋巴结转移的风险较高，建议行颈清扫术。
