Best David L, Jazayeri Hossein E, McHugh Jonathan B, Udager Aaron M, Troost Jonathan P, Powell Corey, Moe Justine
Resident, Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI.
Resident, Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI.
J Oral Maxillofac Surg. 2022 Dec;80(12):1978-1988. doi: 10.1016/j.joms.2022.08.019. Epub 2022 Sep 2.
The presence of extranodal extension (ENE) conveys a poor prognosis in oral cavity squamous cell carcinoma (OSCC); however, there is no consensus regarding whether the histopathologic extent of ENE (e-ENE) may be a more discriminating prognostic indicator. The purpose of this study was to assess the impact of minor ENE (<2.0 mm) versus major ENE (≥ 2.0 mm) on overall survival (OS) and disease-free survival (DFS) in OSCC.
A single-institution, retrospective cohort study was designed using an electronic medical record review. Inclusion criteria included patients with OSCC and cervical node metastasis. All subjects were treated between the years 2009 and 2017 in the Michigan Medicine Department of Oral and Maxillofacial Surgery (Ann Arbor, Michigan). The primary predictor variable was e-ENE, measured as the maximum distance of tumor invasion into extranodal tissue from the outer aspect of the nodal capsule. Primary outcome variables were OS and DFS. Other covariates included demographic data, tumor staging, and histopathologic data. Descriptive statistics were performed. Kaplan-Meier survival plots for OS and DFS were performed. The data were mined for an alternative threshold at which e-ENE may impact survival using Cox proportional hazards models.
One hundred sixty eight subjects were included (91 ENE-negative, 48 minor ENE, and 29 major ENE). Most subjects were male (62%) and the mean age was 62.9 years. Mean follow-up time was 2.97 +/- 2.76 years. There was no statistically significant difference in OS or DFS between minor and major ENE. Five-year OS for minor ENE was 30.4% versus 20.7% for major ENE (P = .28). Five-year DFS for minor ENE was 26.7% versus 18.1% for major ENE (P = .30). Five-year OS and DFS was worse for subjects with ENE-positive disease versus ENE-negative disease (OS: 26.9% vs 63.1%, hazard ratio [HR]: 2.70, 95% confidence interval [CI]: [1.77, 4.10], P < .001; DFS: 23.7% vs 59.7%, HR = 2.55, 95% CI [1.71, 3.79], P < .001). At an alternative threshold of 0.9 mm e-ENE, there was greater DFS in subjects with e-ENE 0.1-0.9 mm versus e-ENE > 0.9 (40.6% vs 18.9%, respectively) (HR = 0.49, 95% CI [0.24, 0.99], P = .047).
There was no independent association between survival and e-ENE at a 2.0-mm threshold.
结外扩展（ENE）的存在提示口腔鳞状细胞癌（OSCC）预后不良；然而，关于ENE的组织病理学范围（e-ENE）是否可能是一个更具区分性的预后指标，目前尚无共识。本研究的目的是评估微小ENE（<2.0 mm）与大ENE（≥2.0 mm）对OSCC总生存期（OS）和无病生存期（DFS）的影响。
采用电子病历回顾设计了一项单机构回顾性队列研究。纳入标准包括OSCC和颈部淋巴结转移患者。所有受试者于2009年至2017年在密歇根大学口腔颌面外科（密歇根州安阿伯）接受治疗。主要预测变量为e-ENE，测量方法为肿瘤从淋巴结包膜外侧侵入结外组织的最大距离。主要结局变量为OS和DFS。其他协变量包括人口统计学数据、肿瘤分期和组织病理学数据。进行描述性统计。绘制OS和DFS的Kaplan-Meier生存曲线。使用Cox比例风险模型挖掘数据，以确定e-ENE可能影响生存的替代阈值。
共纳入168名受试者（91名ENE阴性、48名微小ENE和29名大ENE）。大多数受试者为男性（62%），平均年龄为62.9岁。平均随访时间为2.97±2.76年。微小ENE和大ENE之间的OS或DFS无统计学显著差异。微小ENE的5年OS为30.4%，大ENE为20.7%（P = 0.28）。微小ENE的5年DFS为26.7%，大ENE为18.1%（P = 0.30）。ENE阳性疾病患者的5年OS和DFS比ENE阴性疾病患者更差（OS：26.9%对63.1%，风险比[HR]：2.70，95%置信区间[CI]：[1.77, 4.10]，P < 0.001；DFS：23.7%对59.7%，HR = 2.55，95% CI [1.71, 3.79]，P < 0.001）。在e-ENE的替代阈值为0.9 mm时，e-ENE为0.1 - 0.9 mm的受试者的DFS高于e-ENE > 0.9的受试者（分别为40.6%对18.9%）（HR = 0.49，95% CI [0.24, 0.99]，P = 0.047）。
在2.0 mm阈值时，生存与e-ENE之间无独立关联。
