Kondo Takahito, Tsukahara Kiyoaki, Kawakita Daisuke, Yoshimoto Seiichi, Miura Kouki, Sugasawa Masashi, Chikamatsu Kazuaki, Matsuzuka Takashi, Oze Isao, Kitamura Morimasa, Murakami Yoshiko, Otozai Shinji, Shinozaki Takeshi, Ohba Shinichi, Araki Koji, Mizumachi Takatsugu, Sato Dai, Wakisaka Naohiro, Hirakawa Hitoshi, Hasegawa Yasuhisa
Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Int J Clin Oncol. 2023 Apr;28(4):512-520. doi: 10.1007/s10147-023-02305-1. Epub 2023 Feb 16.
A multicenter, randomized controlled phase III trial was conducted on sentinel lymph node biopsy (SLNB) and elective neck dissection for T1 (depth of invasion ≥ 4 mm)-T2N0M0 oral cavity squamous cell carcinoma. This study identified factors associated with poor prognosis in patients who underwent SLNB based on a subgroup analysis of this trial.
We analyzed 418 sentinel lymph nodes (SLNs) from 132 patients who underwent SLNB. The metastatic SLNs were classified into three categories based on size-isolated tumor cells: < 0.2 mm, micrometastasis: ≥ 0.2 mm and < 2 mm, and macrometastasis: ≥ 2 mm. Three groups were formed based on the number of metastatic SLNs: no metastasis, 1 metastatic node, and ≥ 2 metastatic nodes. The size and number of metastatic SLNs on survival were evaluated using Cox proportional hazard models.
Patients with macrometastasis and ≥ 2 metastatic SLNs had worse overall survival (OS) and disease-free survival (DFS) after adjustment for potential confounders (HR for OS: macrometastasis, 4.85; 95% CI 1.34-17.60; ≥ 2 metastatic SLN, 3.63; 95% CI 1.02-12.89; HR for DFS: macrometastasis, 2.94; 95% CI 1.16-7.44; ≥ 2 metastatic SLN, 2.97; 95% CI 1.18-7.51).
In patients who underwent SLNB, a poorer prognosis was associated with macrometastasis or having ≥ 2 metastatic SLNs.
针对T1期（浸润深度≥4 mm）-T2N0M0口腔鳞状细胞癌患者，开展了一项关于前哨淋巴结活检（SLNB）和选择性颈清扫术的多中心、随机对照III期试验。本研究基于该试验的亚组分析，确定了接受SLNB患者预后不良的相关因素。
我们分析了132例接受SLNB患者的418枚前哨淋巴结（SLN）。根据大小将转移的SLN分为三类：孤立肿瘤细胞＜0.2 mm、微转移：≥0.2 mm且＜2 mm、大转移：≥2 mm。根据转移SLN的数量分为三组：无转移、1个转移淋巴结、≥2个转移淋巴结。使用Cox比例风险模型评估转移SLN的大小和数量对生存的影响。
在对潜在混杂因素进行校正后，发生大转移和≥2枚转移SLN的患者总生存期（OS）和无病生存期（DFS）较差（OS的HR：大转移，4.85；95%CI 1.34 - 17.60；≥2枚转移SLN，3.63；95%CI 1.02 - 12.89；DFS的HR：大转移，2.94；95%CI 1.16 - 7.44；≥2枚转移SLN，2.97；95%CI 1.18 - 7.51）。
在接受SLNB的患者中，预后较差与大转移或有≥2枚转移SLN有关。
