School of Medicine, University of New South Wales, Sydney, Australia.
Department of Head and Neck Surgery, University Hospital of Leicester NHS trust, Leicester, UK.
ANZ J Surg. 2024 May;94(5):854-860. doi: 10.1111/ans.18884. Epub 2024 Jan 30.
To identify adverse pathological features (APF) predicting nodal failure in clinically node negative T1 oral squamous cell carcinoma (OSCC).
This study evaluated patients with T1N0 (≤5 mm depth of invasion (DOI) and ≤2 cm diameter) oral cancers from a prospectively maintained database between 1988 and 2020. All patients underwent surgical excision of the primary lesion without neck dissection. Patients underwent three monthly clinical surveillance and salvage neck dissection was performed if nodal relapse was diagnosed.
Overall, 141 patients were included. Nodal relapse was reported in 16/141 (11.3%) patients. Factors impacting regional recurrence-free survival were DOI ≥3 mm (HR: 2.4, P < 0.001), maximum tumour diameter ≥12 mm (HR: 1.1, P = 0.009), perineural invasion (PNI) (HR 7.5, P = 0.002) and poor differentiation (HR 5.3, P = 0.01). Rates of nodal relapse increased from 2% amongst patients with no APFs to 100% for those with four APFs. Patients with two or more APFs had significantly poorer 5-year regional recurrence-free survival (94.8% vs. 56.3%, P < 0.001).
Patients with T1N0 OSCC with two or more APFs (DOI ≥3 mm, diameter ≥12 mm, PNI or poor differentiations) should be considered for elective neck dissection.
确定预测临床淋巴结阴性 T1 口腔鳞状细胞癌（OSCC）淋巴结失败的不良病理特征（APF）。
本研究评估了 1988 年至 2020 年期间从一个前瞻性维护的数据库中患有 T1N0（≤5mm 浸润深度（DOI）和≤2cm 直径）口腔癌的患者。所有患者均接受原发肿瘤切除术，未行颈部清扫术。患者接受每三个月一次的临床监测，如果诊断出淋巴结复发，则进行挽救性颈部清扫术。
共有 141 例患者纳入研究。141 例患者中有 16 例（11.3%）发生淋巴结复发。影响区域无复发生存的因素包括 DOI≥3mm（HR：2.4，P<0.001）、最大肿瘤直径≥12mm（HR：1.1，P=0.009）、神经周围侵犯（PNI）（HR 7.5，P=0.002）和低分化（HR 5.3，P=0.01）。无 APF 患者的淋巴结复发率为 2%，而有 4 种 APF 的患者的淋巴结复发率为 100%。有两种或更多 APF 的患者的 5 年区域无复发生存率显著较差（94.8%比 56.3%，P<0.001）。
对于 T1N0 OSCC 患者，如果存在两种或更多 APF（DOI≥3mm、直径≥12mm、PNI 或低分化），应考虑选择性颈部清扫术。
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