Iocca Oreste, Copelli Chiara, Campo Flaminia, Petruzzi Gerardo, Pellini Raul, Ramieri Guglielmo, Di Maio Pasquale
Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Torino, Italy.
Department of Maxillofacial Surgery, Hospital University of Bari, University of Bari, Italy.
J Craniomaxillofac Surg. 2025 Apr;53(4):290-300. doi: 10.1016/j.jcms.2024.11.016. Epub 2024 Dec 20.
A growing amount of evidence points at lymph node yield (LNY) and lymph node ratio (LNR) as useful indicators in the prognostic evaluation of patients affected by head and neck squamous cell carcinoma (HNSCC) who require neck dissection. The aim of this study was to assess the importance of LNY and LNR in the prognostic evaluation of head and neck cancer patients.
Included studies were those examining LNY and/or LNR in head and neck cancer patients. We excluded case reports or case series, thyroid cancer or salivary gland cancer studies, a sample size less than 20, and studies with incomplete or missing survival estimate. Of the 2435 studies identified through a database search, 95 were reviewed for full text and 63 were finally included for the final analysis. Electronic databases, including PubMed (MEDLINE), Embase, and Scopus were screened up to January 1, 2024. The systematic review was conducted according to the MOOSE checklist. A set of sub-group meta-analyses were performed for oral cavity, oropharynx, hypopharynx, larynx, and mixed subsites using a random-effects model. Overall survival (OS), Disease Specific Survival (DSS), and Disease-Free Survival (DFS) Hazard Ratios (HR) related to a prespecified LNR and LNY exact value were chosen as summary statistics. Cumulative Hazard Ratios with 95% Confidence Interval (CI) were presented, calculated through the inverse variance method. Heterogeneity was evaluated with I statistics.
Results of the meta-analysis showed increased OS for a higher LNY (HR 1.33 95% CI 1.23-1.45). Regarding the LNR, a lower LNR value has an impact on survival, with an OS HR of 1.96 (95% CI 1.72-2.24). The same was true for DFS (HR 2.43 95% CI 1.82-3.23), and DSS (HR 2.07 95% CI 1.83-2.33).
Our analysis confirms the importance of LNY and LNR as prognostic indicators. Future studies are needed to establish the optimal cut-off values for both factors. LNY and LNR have the potential to be routinely evaluated in patients who undergo neck dissection for HNSCC.
越来越多的证据表明，淋巴结收获量（LNY）和淋巴结比率（LNR）是对头颈部鳞状细胞癌（HNSCC）患者进行预后评估时的有用指标，这些患者需要进行颈部清扫术。本研究的目的是评估LNY和LNR在头颈部癌症患者预后评估中的重要性。
纳入的研究为那些对头颈部癌症患者的LNY和/或LNR进行研究的。我们排除了病例报告或病例系列、甲状腺癌或唾液腺癌研究、样本量小于20的研究以及生存估计不完整或缺失的研究。通过数据库检索确定的2435项研究中，95项进行了全文审查，最终63项纳入最终分析。检索了截至2024年1月1日的电子数据库，包括PubMed（MEDLINE）、Embase和Scopus。系统评价按照MOOSE清单进行。使用随机效应模型对口腔、口咽、下咽、喉和混合亚部位进行了一组亚组荟萃分析。选择与预先指定的LNR和LNY精确值相关的总生存期（OS）、疾病特异性生存期（DSS）和无病生存期（DFS）风险比（HR）作为汇总统计量。呈现通过逆方差法计算的具有95%置信区间（CI）的累积风险比。用I统计量评估异质性。
荟萃分析结果显示，较高的LNY可提高OS（HR 1.33，95%CI 1.23 - 1.45）。关于LNR，较低的LNR值对生存有影响，OS的HR为1.96（95%CI 1.72 - 2.24）。DFS（HR 2.43，95%CI 1.82 - 3.23）和DSS（HR 2.07，95%CI 1.83 - 2.33）也是如此。
我们的分析证实了LNY和LNR作为预后指标的重要性。未来需要开展研究以确定这两个因素的最佳临界值。LNY和LNR有可能在接受HNSCC颈部清扫术的患者中进行常规评估。
