Schartinger Volker Hans, Dejaco Daniel, Fischer Natalie, Lettenbichler-Haug Anna, Anegg Maria, Santer Matthias, Schmutzhard Joachim, Kofler Barbara, Vorbach Samuel, Widmann Gerlig, Riechelmann Herbert
Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
Department of Radiation-Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
Diagnostics (Basel). 2022 Jun 2;12(6):1377. doi: 10.3390/diagnostics12061377.
Clinical lymph node staging in head and neck carcinoma (HNC) is fraught with uncertainties. Established clinical algorithms are available for the problem of occult cervical metastases. Much less is known about clinical lymph node overstaging. We identified HNC patients clinically classified as lymph node positive (cN+), in whom surgical neck dissection (ND) specimens were histopathologically negative (pN0) and in addition the subgroup, in whom an originally planned postoperative radiotherapy (PORT) was omitted. We compared these patients with surgically treated patients with clinically and histopathologically negative neck (cN0/pN0), who had received selective ND. Using a fuzzy matching algorithm, we identified patients with closely similar patient and disease characteristics, who had received primary definitive radiotherapy (RT) with or without systemic therapy (RT ± ST). Of the 980 patients with HNC, 292 received a ND as part of primary treatment. In 128/292 patients with cN0 neck, ND was elective, and in 164 patients with clinically positive neck (cN+), ND was therapeutic. In 43/164 cN+ patients, ND was histopathologically negative (cN+/pN-). In 24 of these, initially planned PORT was omitted. Overall, survival did not differ from the cN0/pN0 and primary RT ± ST control groups. However, more RT ± ST patients had functional problems with nutrition ( = 0.002). Based on these data, it can be estimated that lymph node overstaging is 26% (95% CI: 20% to 34%). In 15% (95% CI: 10% to 21%) of surgically treated cN+ HNC patients, treatment can be de-escalated without the affection of survival.
头颈部癌（HNC）的临床淋巴结分期充满了不确定性。针对隐匿性颈部转移问题，已有既定的临床算法。而对于临床淋巴结过度分期的了解则少得多。我们确定了临床上分类为淋巴结阳性（cN+）的HNC患者，其手术颈部清扫（ND）标本的组织病理学检查为阴性（pN0），此外还确定了一个亚组，即原本计划的术后放疗（PORT）被省略的患者。我们将这些患者与接受了选择性ND且临床和组织病理学检查颈部均为阴性（cN0/pN0）的手术治疗患者进行了比较。使用模糊匹配算法，我们确定了患者和疾病特征密切相似、接受了单纯根治性放疗（RT）或联合全身治疗（RT±ST）的患者。在980例HNC患者中，292例接受了ND作为主要治疗的一部分。在128/292例cN0颈部患者中，ND是选择性的，在164例临床颈部阳性（cN+）患者中，ND是治疗性的。在164例cN+患者中的43例，ND的组织病理学检查为阴性（cN+/pN-）。其中24例原本计划的PORT被省略。总体而言，生存率与cN0/pN0组和单纯RT±ST对照组没有差异。然而，更多接受RT±ST的患者存在营养方面的功能问题（P = 0.002）。基于这些数据，可以估计淋巴结过度分期为26%（95%置信区间：20%至34%）。在15%（95%置信区间：10%至21%）接受手术治疗的cN+HNC患者中，可以在不影响生存的情况下降低治疗强度。
