Gurukeerthi B, Thiagarajan Shivakumar
Kidwai Memorial Institute of Oncology, Bengaluru, India.
Division of Head and Neck, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute (HBNI), Mumbai, India.
J Maxillofac Oral Surg. 2024 Aug;23(4):837-842. doi: 10.1007/s12663-024-02272-8. Epub 2024 Jul 9.
After improvement in the treatment of oral cancers over the years we now see more patients with recurrent oral squamous cell carcinoma (OSCC) and second primary. Recommendations for addressing the neck (ipsilateral and/or contralateral) in these patients are still unclear and debatable.
In this retrospective study we included patients with recurrent and second primary OSCC who underwent surgery between January 2016 and December 2021. We analysed to identify factors and better imaging modality that help predict a pathologically N + neck in these patients.
In our cohort of 219 patients treated for recurrent/second primary OSCC, 131 patients underwent a neck dissection along with surgery for primary, out of which 59 patients had pN + neck. Factors that predicted ipsilateral pN + status were the clinical stage (advanced) = 0.009, 2.724(1.291-5.750), subsite (Tongue + floor of mouth) = 0.01, 3.105(1.305-7.386), previous treatment received (surgery alone) = 0.0472.148(1.011-4.562) and histopathology [poorly differentiated squamous cell carcinoma (PDSCC)] = 0.014, 3.070(1.253-7.519). PET-CECT had the best agreement ( < 0.001, kappa = 0.742) to predict nodal metastasis. There were no factors that could predict contralateral nodal metastasis.
Patients with advanced clinical stage, Tongue + floor of mouth subsite, only surgery done previously, and histopathology (PDSCC) had a higher incidence of ipsilateral nodal metastasis in our cohort.
The online version contains supplementary material available at 10.1007/s12663-024-02272-8.
多年来口腔癌治疗有所改善，如今我们看到更多复发性口腔鳞状细胞癌（OSCC）和第二原发性口腔癌患者。对于这些患者颈部（同侧和/或对侧）处理的建议仍不明确且存在争议。
在这项回顾性研究中，我们纳入了2016年1月至2021年12月期间接受手术的复发性和第二原发性OSCC患者。我们进行分析以确定有助于预测这些患者病理N+颈部的因素和更好的成像方式。
在我们治疗复发性/第二原发性OSCC的219例患者队列中，131例患者在进行原发灶手术时同时进行了颈部清扫，其中59例患者有pN+颈部。预测同侧pN+状态的因素有临床分期（晚期）=0.009，2.724（1.291 - 5.750），亚部位（舌+口底）=0.01，3.105（1.305 - 7.386），先前接受的治疗（仅手术）=0.047，2.148（1.011 - 4.562）以及组织病理学[低分化鳞状细胞癌（PDSCC）]=0.014，3.070（1.253 - 7.519）。PET - CECT在预测淋巴结转移方面具有最佳一致性（<0.001，kappa = 0.742）。没有因素能够预测对侧淋巴结转移。
在我们的队列中，临床分期晚期、舌+口底亚部位、先前仅进行了手术以及组织病理学（PDSCC）的患者同侧淋巴结转移发生率较高。
在线版本包含可在10.1007/s12663 - 024 - 02272 - 8获取的补充材料。
