Di Giorgio Danilo, Della Monaca Marco, Nocini Riccardo, Battisti Andrea, Ferri Federica Orsina, Priore Paolo, Terenzi Valentina, Valentini Valentino
Department of Odontostomatological and Maxillofacial Sciences, La Sapienza University of Rome, 00185 Rome, Italy.
Unit of Otolaryngology, Head and Neck Department, University of Verona, 37134 Verona, Italy.
J Clin Med. 2024 Nov 22;13(23):7067. doi: 10.3390/jcm13237067.
: Oral cavity squamous-cell carcinoma is among the most frequent head and neck neoplasms. Early-stage T1/T2N0 accounts for 40/45% of new diagnoses. Of these, about 30% of cases hide occult metastases in the neck. The management of clinically N0 neck is of paramount importance and is still being debated. : The medical records of patients with a clinical diagnosis of early-stage T1-T2N0 carcinoma of the oral cavity between 2011 and 2021 were retrospectively analysed. The inclusion criteria were complete medical and radiological records, pT1-2 pathology staging, and a minimum follow-up of 24 months. Biographical, management, and survival data were analysed using IBM SPSS Statistics [28.0.1.1]; IBM Corp., Armonk, NY, USA). : A total of 121 patients met the inclusion criteria. The tongue was the most affected site, with 52 cases. All patients underwent resection of the primary tumour; for neck management, 47 (38.8%) underwent elective neck dissection, 36 underwent follow-up, and 11 underwent sentinel lymph node biopsy. A total of 59 cases were staged as T1 and 62 as T2; in 97 (80.2%) cases, the neck was confirmed as N0; in 10 (8.3%), N1; in 1 case, N2a; in 8, N2b; in 2, N2c; and in 3, N3b. The mean DOI was 4.8 mm. In a Cox regression, a statistically significant association was shown between overall survival and pN staging ( < 0.05). Kaplan-Meier analysis showed a statistically significant difference between different regimens of management of the neck in terms of overall survival, disease-free survival, and disease-specific survival in favour of elective neck dissection and sentinel lymph node biopsy compared to watchful policy ( < 0.05). : Elective neck dissection and sentinel lymph node biopsy proved to be safe and oncologically effective in the treatment of clinically N0 early-stage oral carcinoma.
口腔鳞状细胞癌是最常见的头颈部肿瘤之一。早期T1/T2N0病例占新诊断病例的40%/45%。其中，约30%的病例颈部存在隐匿性转移。临床N0颈部的处理至关重要，目前仍存在争议。
对2011年至2021年间临床诊断为口腔早期T1 - T2N0癌的患者病历进行回顾性分析。纳入标准为完整的医学和放射学记录、pT1 - 2病理分期以及至少24个月的随访。使用IBM SPSS Statistics [28.0.1.1]（IBM公司，美国纽约州阿蒙克）分析患者的传记、治疗和生存数据。
共有121例患者符合纳入标准。舌部是最常受累部位，有52例。所有患者均接受了原发肿瘤切除术；对于颈部处理，47例（38.8%）接受了择期颈部清扫术，36例接受了随访，11例接受了前哨淋巴结活检。共有59例分期为T1，62例为T2；97例（80.2%）病例颈部被确认为N0；10例（8.3%）为N1；1例为N2a；8例为N2b；2例为N2c；3例为N3b。平均肿瘤浸润深度为4.8毫米。在Cox回归分析中，总生存与pN分期之间存在统计学显著关联（<0.05）。Kaplan - Meier分析显示，与观察策略相比，在总生存、无病生存和疾病特异性生存方面，不同颈部处理方案之间存在统计学显著差异，支持择期颈部清扫术和前哨淋巴结活检（<0.05）。
事实证明，择期颈部清扫术和前哨淋巴结活检在治疗临床N0早期口腔癌方面是安全且具有肿瘤学疗效的。
