为准确进行口腔舌鳞状细胞癌的淋巴结分期及获得良好预后所需检查的最佳淋巴结数量。

The optimal number of examined lymph nodes for accurate nodal staging and favorable prognosis of oral tongue squamous cell carcinoma.

作者信息

Zhuge Lingdun, Cai Huizhu, Huang Zehao, Wang Shixu, Li Zhengjiang

机构信息

Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Oral Oncol. 2023 May;140:106368. doi: 10.1016/j.oraloncology.2023.106368. Epub 2023 Mar 24.

DOI:10.1016/j.oraloncology.2023.106368

PMID:36966671

Abstract

OBJECTIVE

The study aimed to determine the optimal count of examined lymph nodes (ELN) for accurate assessment of lymph node status and favorable long-term survival in patients with oral tongue squamous cell carcinoma (OTSCC) who received radical resection.

METHODS

Patients with OTSCC who received radical resection between 2004 and 2015 were enrolled from the Surveillance, Epidemiology, and End Results database (SEER) and were randomly divided into two cohorts. The association of ELN count with nodal migration and overall survival (OS) was analyzed using a multivariate regression model with the adjustment of relevant factors. Locally weighted scatterplot smoothing (LOWESS) and 'strucchange' package were adopted to identify the optimal cut points using R.

RESULTS

A total of 2077 patients were included in this study. The optimal cut points of ELN count for accurate nodal staging and favorable OS were 19 and 15, respectively. The probability of detecting positive lymph nodes (PLN) significantly increased in patients with ELN count ≥ 19 in comparison to those with ELN count < 19 (training set, P < 0.001; validation set, P = 0.012). A better postoperative prognosis was observed in patients with ELN count ≥ 15 than those with fewer ELN (training set, P = 0.001, OR: 0.765; validation set, P = 0.016, OR: 0.678).

CONCLUSION

The optimal cut point of ELN count to ensure the accuracy of nodal staging and to achieve a favorable postoperative prognosis were 19 and 15, respectively. The ELN count beyond the cutoff values might improve the accuracy of cancer staging and OS.

摘要

目的

本研究旨在确定接受根治性切除术的口腔舌鳞状细胞癌（OTSCC）患者中，用于准确评估淋巴结状态及实现良好长期生存的最佳检查淋巴结计数（ELN）。

方法

从监测、流行病学和最终结果数据库（SEER）中纳入2004年至2015年间接受根治性切除术的OTSCC患者，并随机分为两个队列。使用多因素回归模型并调整相关因素，分析ELN计数与淋巴结转移及总生存（OS）的关联。采用局部加权散点图平滑法（LOWESS）和“strucchange”软件包，利用R语言确定最佳切点。

结果

本研究共纳入2077例患者。准确进行淋巴结分期及实现良好OS的ELN计数最佳切点分别为19和15。ELN计数≥19的患者与ELN计数<19的患者相比，检测到阳性淋巴结（PLN）的概率显著增加（训练集，P<0.001；验证集，P=0.012）。ELN计数≥15的患者术后预后优于ELN计数较少的患者（训练集，P=0.001，OR：0.765；验证集，P=0.016，OR：0.678）。