Peryassú Bernardo Cacciari, Nicolau-Neto Pedro, da Costa Eduardo Wanderley Estanislau, Santos Izabella Costa, Ribeiro Pinto Luis Felipe, Dias Fernando L
Seção de Cirurgia de Cabeça e Pescoço, Instituto Nacional de Câncer - INCA, Rio de Janeiro, RJ, Brazil; Programa de Carcinogênese Molecular, Instituto Nacional de Câncer - INCA, Rio de Janeiro, RJ, Brazil.
Programa de Carcinogênese Molecular, Instituto Nacional de Câncer - INCA, Rio de Janeiro, RJ, Brazil.
Oral Oncol. 2025 Aug;167:107429. doi: 10.1016/j.oraloncology.2025.107429. Epub 2025 Jun 13.
Cervical lymph node metastasis in glottic laryngeal squamous cell carcinoma (LSCC) increases the chance of tumor recurrence and significantly impacts the prognosis. This scenario is worse when the cervical metastasis is not identified in the clinical evaluation, resulting in cervical occult metastasis. Therefore, it is necessary to explore the oncological outcome related to cervical occult metastasis in glottic LSCC and describe features associated with this aggressiveness marker.
Retrospective study with glottic LSCC patients without cervical metastasis at the clinical evaluation (cN0), surgically treated with cervical dissection in the Instituto Nacional de Câncer (Brazil). cT1 samples were excluded because none of them presented cervical occult metastasis.
Cervical occult metastasis was observed in 39 (23.78 %) of 164 cN0 glottic LSCC patients. Regarding their neck levels, 2.7 % of patients had cervical metastasis in neck level I, 22 in neck level II, 16 in neck level III, 15 in neck level IV, and four in neck level VI. Cervical occult metastasis was associated with lymphovascular involvement (OR = 9.41), subglottic involvement (OR = 4.48), thyroid involvement (OR = 8.53), and tobacco smoking (OR = 5.70). Finally, cervical occult metastasis was an independent prognostic factor for overall (HR = 7.40), disease-specific (HR = 11.90), and disease-free (HR = 9.07) survivals.
We observed a significant frequency of cervical occult metastasis in glottic LSCC, negatively impacting the prognosis. Cervical occult metastasis was associated with a history of cigarette smoking, subglottic invasion, and lymphovascular and thyroid involvement. Consequently, the surgical planning for neck dissection in patients exhibiting these characteristics could be adjusted to enhance the effectiveness of oncological treatment.
声门型喉鳞状细胞癌（LSCC）发生颈部淋巴结转移会增加肿瘤复发几率，并显著影响预后。若在临床评估中未发现颈部转移，即发生颈部隐匿性转移时，情况会更糟。因此，有必要探究声门型LSCC颈部隐匿性转移相关的肿瘤学结局，并描述与这种侵袭性标志物相关的特征。
对在巴西国立癌症研究所接受手术治疗且临床评估无颈部转移（cN0）的声门型LSCC患者进行回顾性研究。排除cT1样本，因为它们均未出现颈部隐匿性转移。
164例cN0声门型LSCC患者中，39例（23.78%）出现颈部隐匿性转移。就颈部区域而言，2.7%的患者在I区发生颈部转移，II区22例，III区16例，IV区15例，VI区4例。颈部隐匿性转移与脉管侵犯（OR = 9.41）、声门下侵犯（OR = 4.48）、甲状腺侵犯（OR = 8.53）及吸烟（OR = 5.70）相关。最后，颈部隐匿性转移是总生存（HR = 7.40）、疾病特异性生存（HR = 11.90）和无病生存（HR = 9.07）的独立预后因素。
我们观察到声门型LSCC颈部隐匿性转移发生率较高，对预后产生负面影响。颈部隐匿性转移与吸烟史、声门下侵犯以及脉管和甲状腺侵犯相关。因此，对于具有这些特征的患者，颈部清扫的手术规划可进行调整，以提高肿瘤治疗效果。
