cN0HPV 阴性口咽鳞癌行 IV 区颈部清扫术：一项回顾性队列研究。
Level IV neck dissection in cN0 HPV-negative oropharyngeal squamous cell carcinoma: a retrospective cohort study.
机构信息
Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, 639, Zhi Zao Ju Road, Shanghai, 200011, China.
出版信息
BMC Cancer. 2022 May 12;22(1):535. doi: 10.1186/s12885-022-09609-x.
BACKGROUND
As opposed to observation of the neck, elective neck dissection has a survival benefit for cN0 oropharyngeal squamous cell carcinoma (OPSCC). However, there are limited date on level IV neck dissection in human papillomavirus (HPV)-negative OPSCC because most earlier studies did not stratify by P16 or HPV status. Thus, whether to exclude level IV from selective dissection (SND) of cN0 HPV-negative OPSCC remains controversial.
METHODS
In this single-center retrospective cohort study, disease-free survival (DFS) was estimated as the primary endpoint for 124 cN0 HPV-negative OPSCC patients who received SND of levels I-III (Group A) and I-IV (Group B). Overall survival (OS) and disease-specific survival (DSS) were considered secondary endpoints.
RESULTS
For the entire cohort, the 5-year DFS rates of Groups A and B were 55.0% and 60.1%, respectively. Five-year OS rates were 58.9% and 61.5%, and 5-year DSS rates were 74.0% and 64.8%, respectively. Group B did not show higher 5-year DFS, OS, or DSS than Group A.
CONCLUSIONS
This retrospective cohort study validated that in cN0 HPV-negative OPSCC, SND including level IV does not have substantial benefits regarding DFS, OS or DSS.
背景
与观察颈部相比，择期颈清扫术对 cN0 口咽鳞状细胞癌（OPSCC）患者具有生存获益。然而，由于大多数早期研究没有按 P16 或 HPV 状态分层，因此关于 HPV 阴性 OPSCC 中 IV 级颈清扫的数据有限。因此，HPV 阴性 cN0 OPSCC 是否需要从选择性清扫（SND）中排除 IV 级仍然存在争议。
方法
在这项单中心回顾性队列研究中，124 例接受 I-III 级（A 组）和 I-IV 级（B 组）SND 的 cN0 HPV 阴性 OPSCC 患者的无病生存（DFS）被估计为主要终点。总生存（OS）和疾病特异性生存（DSS）被认为是次要终点。
结果
对于整个队列，A 组和 B 组的 5 年 DFS 率分别为 55.0%和 60.1%。5 年 OS 率分别为 58.9%和 61.5%，5 年 DSS 率分别为 74.0%和 64.8%。B 组在 5 年 DFS、OS 或 DSS 方面并未表现出比 A 组更高的结果。
结论
这项回顾性队列研究验证了在 cN0 HPV 阴性 OPSCC 中，包括 IV 级的 SND 并没有在 DFS、OS 或 DSS 方面带来实质性的获益。
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