Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.
Clin Oral Investig. 2024 Aug 6;28(9):466. doi: 10.1007/s00784-024-05863-4.
Cervical lymph node metastasis (CLNM) is one of the most relevant influencing factors for the oncological outcome of patients with oral squamous cell carcinoma (OSCC). Several studies showed that the tumors depth of invasion (DOI) influences the risk for CLNM, however varying across the oral subsites. The aim of this study is to investigate the role of DOI and other risk factors in OSCC of the tongue in relation to the occurrence of occult CLNM.
In this retrospective study, n = 139 patients with primary OSCC of the tongue, treated by complete surgical resection (R0) with curative intention between 2013 and 2021, were included. For data analysis, epidemiologic data as well as preoperative tumor staging, surgical therapy including neck management, histopathological tumor data and follow-up were considered. Uni- and multivariate logistic regression were used to determine association between histopathological risk factors and the occurrence of occult CLNM.
The rate of occult cervical metastasis was 19.4%. T-staging, cervical nodal disease (pN+) and lymphatic invasion were significantly associated with reduced OS and RFS. While DOI had no relevant influence on the OS and RFS (p = 0.88 and p = 0.91 respectively), there was significant correlation between DOI and the occurrence of occult CLNM (OR: 1.17, 95%CI: 1.05-1.30; p < 0.01). The optimal cutoff in predicting occult CLNM was 6 mm (Sensitivity: 84.2%, Specificity: 73.5%, AUC: 0.75).
The DOI is a helpful risk parameter to predict the occurrence of occult nodal disease in OSCC of the tongue. Given the critical decision cutoff between 2 and 4 mm DOI for performing elective neck dissection in the current guidelines, our data suggests that in these cases, surgical de-escalation could be feasible with close follow-up.
This study highlights the relevance of DOI as a risk parameter in the prediction of CLNM with the aim to specify the individual patient risk and to deescalate surgical therapy in order to decrease comorbidities while improving the oncological prognosis.
颈部淋巴结转移（CLNM）是影响口腔鳞状细胞癌（OSCC）患者肿瘤学结局的最重要相关因素之一。多项研究表明，肿瘤浸润深度（DOI）影响 CLNM 的风险，但在口腔不同部位存在差异。本研究旨在探讨 DOI 及其他危险因素在舌部 OSCC 与隐匿性 CLNM 发生中的作用。
本回顾性研究纳入了 2013 年至 2021 年间接受根治性手术（R0）治疗的 139 例原发性舌部 OSCC 患者。数据分析包括流行病学数据、术前肿瘤分期、手术治疗包括颈部管理、组织病理学肿瘤数据和随访。采用单因素和多因素逻辑回归来确定组织病理学危险因素与隐匿性 CLNM 发生之间的关联。
隐匿性颈部转移率为 19.4%。T 分期、颈部淋巴结疾病（pN+）和淋巴血管侵犯与降低 OS 和 RFS 显著相关。虽然 DOI 对 OS 和 RFS 无显著影响（p=0.88 和 p=0.91），但 DOI 与隐匿性 CLNM 的发生显著相关（OR：1.17，95%CI：1.05-1.30；p<0.01）。预测隐匿性 CLNM 的最佳截断值为 6mm（敏感性：84.2%，特异性：73.5%，AUC：0.75）。
DOI 是预测舌部 OSCC 隐匿性淋巴结疾病发生的有用风险参数。鉴于目前指南中 2-4mm DOI 之间进行选择性颈部清扫的关键决策截断值，我们的数据表明，在这些情况下，通过密切随访，手术降级可能是可行的。
本研究强调了 DOI 作为预测 CLNM 的风险参数的相关性，旨在确定个体患者的风险，并降低手术治疗的分级，以减少并发症，同时改善肿瘤学预后。
