Huang Hui-Shan, Tsai Ming-Hsien, Chuang Hui-Ching, Lin Yu-Tsai, Yang Kun-Lin, Lu Hui, Chien Chih-Yen
Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Cancer Manag Res. 2022 Nov 10;14:3151-3158. doi: 10.2147/CMAR.S382394. eCollection 2022.
It is well known that p16 negative oropharyngeal squamous cell carcinoma (OPSCC) has a high probability of spreading to the ipsilateral neck. However, no consensus exists as to whether to perform elective treatment for clinical nodal negative in contralateral neck.
A total of 85 patients with p16 negative OPSCC who underwent primary tumor excision and bilateral neck dissections between 2005 and 2018 were analyzed retrospectively. Clinicopathologic variables were used to identify factors predicting occult contralateral nodal metastasis (OCNM). A nomogram was developed to assess the risk of OCNM and the model was validated internally by using bootstrap resampling.
The overall prevalence of pathologically positive contralateral nodes was 30.6% (26/85) in our cohort, and the rate of OCNM was 18.3% (11/60). The presence of ipsilateral clinical extranodal extension (cENE) was significantly associated with contralateral neck metastasis (odds ratio, 5.662; 95% CI, 2.079-15.415) with increased risk of OCNM (odds ratio, 4.271; 95% CI, 1.045-17.458). Moreover, the concordance index of the proposed nomogram model without ipsilateral cENE was 0.623 and could increase to 0.717 with the inclusion of ipsilateral cENE in the calculation.
The risk of OCNM in p16 negative OPSCC with ipsilateral cENE is notable. Ipsilateral cENE-based nomogram might assist in individual decision-making regarding contralateral nodal negative neck management and help avoid the over- and under-treatment of p16 negative OPSCC.
众所周知，p16阴性口咽鳞状细胞癌（OPSCC）有很高的概率扩散至同侧颈部。然而，对于对侧颈部临床淋巴结阴性是否进行选择性治疗尚无共识。
回顾性分析了2005年至2018年间共85例接受原发性肿瘤切除及双侧颈部清扫术的p16阴性OPSCC患者。采用临床病理变量来确定预测隐匿性对侧淋巴结转移（OCNM）的因素。构建了列线图以评估OCNM的风险，并通过自助重采样在内部对模型进行验证。
在我们的队列中，对侧淋巴结病理阳性的总体患病率为30.6%（26/85），OCNM发生率为18.3%（11/60）。同侧临床结外扩展（cENE）的存在与对侧颈部转移显著相关（优势比，5.662；95%可信区间，2.079 - 15.415），且OCNM风险增加（优势比，4.271；95%可信区间，1.045 - 17.458）。此外，所提出的不包括同侧cENE的列线图模型的一致性指数为0.623，在计算中纳入同侧cENE后可增至0.717。
有同侧cENE的p16阴性OPSCC发生OCNM的风险显著。基于同侧cENE的列线图可能有助于对侧淋巴结阴性颈部管理的个体化决策，并有助于避免p16阴性OPSCC的过度治疗和治疗不足。
