Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
Ann Surg Oncol. 2023 Jul;30(7):4220-4230. doi: 10.1245/s10434-023-13434-2. Epub 2023 Apr 18.
The presence of single-node metastasis (Ns) sometimes could be encountered in patients with oral squamous cell carcinoma (OSCC). The survival outcome for different Ns should be worthy of discussion.
Patients diagnosed with OSCC at the National Taiwan University Hospital between January 2007 and December 2018 were reviewed. All patients with Ns were classified into two groups: with and without extranodal extension (ENE).
We analyzed 311 OSCC patients with Ns: 77 (24.76%) with and 234 (75.24%) without ENE. Lymph node (LN) >3 cm was the only significant factor associated with ENE (odds ratio 17.21, p < 0.001). The 5-year, disease-free survival of N/N and N patients was 60.5% and 49.4%, respectively (p = 0.04), and the 5-year overall survival was 63.1% and 33.6%, respectively (p = 0.0001). Four fifths of Ns patients with LN >3 cm were upgraded to N category as ENE+. Postoperative radiotherapy (PORT) could provide significant benefit in regional control for Ns patients with (p = 0.03) and without (p = 0.0004) other adverse features. After multivariant Cox analysis, ENE+ was a modest and significant risk factor for disease-free (p = 0.08) and overall survival (p = 0.001). By contrast, the LN>3cm and N category were not significant risk factors for disease-free and overall survival.
For OSCC patients with Ns, the survival outcome between N category and N/N category was significantly different. After ENE+ upgrades (>80%), there were fewer N patients, and these patients became more comparable to N patients. PORT could significantly improve regional control for Ns patients.
口腔鳞状细胞癌（OSCC）患者有时会出现单节点转移（Ns）。不同 Ns 的生存结果值得讨论。
回顾了 2007 年 1 月至 2018 年 12 月在国立台湾大学医院诊断为 OSCC 的患者。将所有 Ns 患者分为两组：有和没有结外扩展（ENE）。
我们分析了 311 例 Ns 的 OSCC 患者：77 例（24.76%）有 ENE，234 例（75.24%）没有 ENE。淋巴结（LN）>3cm 是唯一与 ENE 相关的显著因素（优势比 17.21，p<0.001）。N/N 和 N 患者的 5 年无病生存率分别为 60.5%和 49.4%（p=0.04），5 年总生存率分别为 63.1%和 33.6%（p=0.0001）。四分之三的 LN>3cm 的 Ns 患者被升级为 ENE+的 N 类。术后放疗（PORT）可显著提高 Ns 患者的区域控制率（p=0.03）和无其他不良特征的 Ns 患者（p=0.0004）。多变量 Cox 分析后，ENE+是无病（p=0.08）和总生存（p=0.001）的适度显著危险因素。相比之下，LN>3cm 和 N 类不是无病和总生存的显著危险因素。
对于 Ns 的 OSCC 患者，N 类和 N/N 类之间的生存结果有显著差异。在 ENE+升级（>80%）后，N 患者较少，这些患者与 N 患者更为可比。PORT 可显著提高 Ns 患者的区域控制率。
