Le John M, Sayre Kelly S, Sesanto Rae, Seri Chaitra, Ying Yedeh P, Morlandt Anthony B
Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA.
J Maxillofac Oral Surg. 2024 Aug;23(4):959-965. doi: 10.1007/s12663-023-02035-x. Epub 2023 Nov 8.
This study aims to identify the rate of occult nodal metastasis (ONM), risk factors associated with ONM, and compare regional recurrence (RR), 2-year disease-free survival (DFS) in patients treated with elective neck dissection (END) versus expectant management (OBS) for primary T1-T2 gingival squamous cell carcinoma (GSCC) of the maxilla and mandible.
A retrospective analysis was conducted and included patients from 2014 to 2021 who were treated at a tertiary referral center.
Twenty patients underwent END and 36 were managed expectantly, with a mean follow-up period of 28 months. ONM was observed in 26% of the study cohort with 16.7% occurring in the maxilla and 36.4% in the mandible. No specific histopathologic features were predictive for ONM. No regional recurrence occurred. Local recurrence occurred in 5% and 2.8% of END and OBS groups, respectively. Two-year DFS were comparable between the END (93.8%) versus OBS (83.9%) as well as maxilla (90.9%) versus mandible (83.4%), P > 0.05.
ONM remains variable in cT1-T2N0 GSCC with a greater incidence occurring in the mandible when compared to the maxilla, respectively. An END should be strongly considered for mandibular GSCC. Overall, END for the N0 neck has been shown to provide significant overall and disease-free survival benefits. However, further prospective randomized studies are needed to verify risk factors for ONM and validate the disease-related survival benefit of an elective neck dissection in this patient population.
本研究旨在确定隐匿性淋巴结转移（ONM）的发生率、与ONM相关的危险因素，并比较接受择区性颈清扫术（END）与观察等待处理（OBS）的上颌骨和下颌骨原发性T1-T2牙龈鳞状细胞癌（GSCC）患者的区域复发（RR）、2年无病生存率（DFS）。
进行回顾性分析，纳入2014年至2021年在一家三级转诊中心接受治疗的患者。
20例患者接受了END，36例接受了观察等待处理，平均随访期为28个月。在26%的研究队列中观察到ONM，其中16.7%发生在上颌骨，36.4%发生在下颌骨。没有特定的组织病理学特征可预测ONM。未发生区域复发。END组和OBS组的局部复发率分别为5%和2.8%。END组（93.8%）与OBS组（83.9%）以及上颌骨组（90.9%）与下颌骨组（83.4%）的2年DFS相当，P＞0.05。
在cT1-T2N0 GSCC中，ONM发生率仍存在差异，下颌骨的发生率高于上颌骨。对于下颌骨GSCC，应强烈考虑行END。总体而言，已证明对N0颈部行END可提供显著的总生存和无病生存获益。然而，需要进一步的前瞻性随机研究来验证ONM的危险因素，并验证择区性颈清扫术对该患者群体的疾病相关生存获益。
