Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Otolaryngology - Head and Neck Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA.
Oral Oncol. 2024 Dec;159:107070. doi: 10.1016/j.oraloncology.2024.107070. Epub 2024 Oct 10.
In head and neck cancer surgery, several studies have demonstrated the prognostic significance of lymph node yield (LNY). To our knowledge, no review has evaluated both the contributing factors to LNY and its impact on survival outcomes across all head and neck squamous cell carcinoma (HNSCC) subsites.
A scoping review of LNY in HNSCC was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework to answer the following research questions: 1) Which surgeon, pathologist, and patient characteristics influence LNY? 2) Which anatomic subsites does LNY impact survival?
Surgeon experience and variation in pathology protocols and personnel can impact LNY. Extent of nodal dissection, advanced tumor characteristics, and treatment at an academic facility are associated with increased LNY. Patient characteristics such as age <40, male gender, and BMI > 30 are associated with increased LNY. In the oral cavity, LNY > 18 is an independent predictor of improved overall survival (OS), disease free survival (DFS), and disease-specific survival (DSS). In the oropharynx, published studies show mixed results with regards to the impact of LNY on OS, DFS, and DSS. LNY has not been associated with OS or DFS in the larynx, irrespective of nodal threshold.
Provider and patient characteristics may impact LNY. LNY ≥ 18 is associated with a survival benefit in the oral cavity and HNSCC overall. Further investigation of LNY particularly in prospective clinical trials is required prior to its adoption as a quality metric in HNSCC.
在头颈部癌症手术中，多项研究已经证明了淋巴结产量（LNY）的预后意义。据我们所知，尚无综述评估 LNY 的影响因素及其对头颈部鳞状细胞癌（HNSCC）所有亚部位的生存结局的影响。
根据系统评价和荟萃分析扩展的首选报告项目（PRISMA-ScR）框架对头颈部鳞状细胞癌中 LNY 的范围进行综述，以回答以下研究问题：1）哪些外科医生、病理学家和患者特征会影响 LNY？2）LNY 影响哪些解剖亚部位的生存？
外科医生的经验以及病理协议和人员的变化可能会影响 LNY。淋巴结清扫的范围、肿瘤的进展程度和在学术机构进行的治疗与 LNY 的增加有关。患者特征如年龄<40 岁、男性和 BMI>30 与 LNY 的增加有关。在口腔中，LNY>18 是总生存率（OS）、无病生存率（DFS）和疾病特异性生存率（DSS）的独立预测因子。在口咽，关于 LNY 对 OS、DFS 和 DSS 的影响，发表的研究结果存在差异。无论淋巴结阈值如何，LNY 与喉癌的 OS 或 DFS 均无关。
提供者和患者的特征可能会影响 LNY。LNY≥18 与口腔和头颈部鳞状细胞癌的生存获益相关。在将其作为头颈部鳞状细胞癌的质量指标采用之前，需要进一步在前瞻性临床试验中对 LNY 进行研究。
