van Leer Bram, Leus Alet J G, van Dijk Boukje A C, van Kester Marloes S, Halmos Gyorgy B, Diercks Gilles F H, van der Vegt Bert, Vister Jeroen, Rácz Emoke, Plaat Boudewijn E C
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Front Oncol. 2022 May 30;12:874295. doi: 10.3389/fonc.2022.874295. eCollection 2022.
The extent of a neck dissection for patients with metastasis of cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is still subject to debate and clear guidelines are lacking. Tumor characteristics like size, differentiation and tumor location are known risk factors for lymph node metastasis (LNM). There is some evidence that, depending on tumor location, LNM follows a specific pattern. This study aims to identify which tumor characteristics can predict the pattern and extent of LNM.
In this cohort study 80 patients were included, who underwent a primary neck dissection for LNM of HNcSCC between 2003 and 2018 at the University Medical Center Groningen, the Netherlands. Retrospective data was collected for primary tumor characteristics and LNM and included surgical and follow-up data. Influence of tumor characteristics on the extent of LNM was analyzed using non-parametric tests. Logistic regression analysis were used to identify a metastasis pattern based on the primary tumor location.
Only primary tumor location was associated with the pattern of LNM. HNcSCC of the ear metastasized to level II (OR = 2.6) and the parotid gland (OR = 3.6). Cutaneous lip carcinoma metastasized to ipsilateral and contralateral level I (OR = 5.3). Posterior scalp tumors showed a metastasis pattern to level II (OR = 5.6); level III (OR = 11.2), level IV (OR = 4.7) and the parotid gland (OR = 10.8). Ear canal tumors showed a low risk of LNM for all levels. The extent of LNM was not related to age or any tumor characteristics i.e. tumor diameter, infiltration depth, differentiation grade, perineural growth and vascular invasion.
Primary tumor location determines the LNM pattern. Whereas known unfavorable tumor characteristics did not relate to the extent of LNM. Location guided limited neck dissection combined with parotidectomy will treat most patients adequately.
头颈部皮肤鳞状细胞癌（HNcSCC）转移患者的颈部清扫范围仍存在争议，且缺乏明确的指南。肿瘤大小、分化程度和肿瘤位置等肿瘤特征是已知的淋巴结转移（LNM）风险因素。有证据表明，根据肿瘤位置，LNM遵循特定模式。本研究旨在确定哪些肿瘤特征可预测LNM的模式和范围。
在这项队列研究中，纳入了80例患者，他们于2003年至2018年期间在荷兰格罗宁根大学医学中心因HNcSCC的LNM接受了初次颈部清扫。收集了关于原发性肿瘤特征和LNM的回顾性数据，包括手术和随访数据。使用非参数检验分析肿瘤特征对LNM范围的影响。采用逻辑回归分析根据原发性肿瘤位置确定转移模式。
仅原发性肿瘤位置与LNM模式相关。耳部HNcSCC转移至Ⅱ区（比值比[OR]=2.6）和腮腺（OR=3.6）。唇部皮肤癌转移至同侧和对侧Ⅰ区（OR=5.3）。后头皮肿瘤的转移模式为Ⅱ区（OR=5.6）、Ⅲ区（OR=11.2）、Ⅳ区（OR=4.7）和腮腺（OR=10.8）。耳道肿瘤在所有区域的LNM风险均较低。LNM的范围与年龄或任何肿瘤特征无关，即肿瘤直径、浸润深度、分化程度、神经周围生长和血管侵犯。
原发性肿瘤位置决定LNM模式。而已知的不良肿瘤特征与LNM范围无关。位置引导下的有限颈部清扫联合腮腺切除术将使大多数患者得到充分治疗。
