Sentinel Lymph Node Biopsy Versus Elective Neck Dissection for Stage I to II Oral Cavity Cancer
Sentinel Lymph Node Biopsy Versus Elective Neck Dissection for Stage I to II Oral Cavity Cancer
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DOI：
10.1002/lary.27323
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发表时间：
2019-01-01
期刊：
影响因子：
2.6
通讯作者：
Samant, Sandeep
中科院分区：
文献类型：
--
作者：
Cramer, John D.;Sridharan, Shaum;Samant, Sandeep
目的前哨淋巴结活检（SLNB）已被证明是对早期口腔鳞状细胞癌（OCSCC）进行颈部分期的准确技术，并已被纳入治疗指南，作为替代选择性颈清扫术（END）的一种选择。然而，SLNB在美国的使用情况仍不清楚，现有的前瞻性研究没有直接比较SLNB和END之间的生存率。方法我们对2012年至2015年在国家癌症数据库中接受颈部分期的I至II期OCSCC（cT 1 - 2cN 0 cM 0）患者进行了回顾性队列研究。我们比较了接受SLNB与END的患者的实践模式和结局。结果我们确定了8，328名合格患者，中位随访时间为35.4个月。SLNB用于240例患者，占I至II期OCSCC的2.9%。63.8%的SLNB患者避免了完成颈清扫术。SLNB与围手术期发病率降低相关，中位住院时间为1.0天，而END后为3.0天（P < 0.001）。SLNB后围手术期30天死亡率为0%，END后为0.7%（P = 0.42）。SLNB后3年总生存率为82.0%，END后为77.5%（P = 0.40）。调整后，SLNB与END患者的总生存期相当（调整后风险比1.03，置信区间0.67-1.59）。结论SLNB治疗I ~ II期口腔鳞癌与END相比，住院时间缩短，总生存率相当。尽管有这些属性，SLNB仍然很少在美国使用。
Objectives Sentinel lymph node biopsy (SLNB) has been shown to be an accurate technique for staging the neck in early-stage oral cavity squamous cell carcinoma (OCSCC) and has been incorporated in treatment guidelines as an option instead of elective neck dissection (END). However, utilization of SLNB in the United States remains unclear, and existing prospective studies did not directly compare survival between SLNB and END. Methods We conducted a retrospective cohort study of patients with stage I to II OCSCC (cT1-2cN0cM0) who underwent staging of the neck in the National Cancer Data Base from 2012 to 2015. We compared the practice patterns and outcomes of patients who underwent SLNB versus END. Results We identified 8,328 eligible patients with a median follow-up of 35.4 months. SLNB was used for 240 patients, or 2.9% of stage I to II OCSCC. Completion neck dissection was avoided in 63.8% of patients undergoing SLNB. SLNB was associated with reduced perioperative morbidity, with median length of hospital stay of 1.0 days versus 3.0 days after END (P < 0.001). Perioperative 30-day mortality was 0% after SLNB versus 0.7% after END (P = 0.42). Overall 3-year survival was 82.0% after SLNB and 77.5% after END (P = 0.40). After adjustment, overall survival was equivalent between patients who underwent SLNB versus END (adjusted hazard ratio 1.03, confidence interval 0.67-1.59). Conclusions SLNB for stage I to II OCSCC is associated with reduced length of hospital stay and equivalent overall survival compared with END. Despite these attributes, SLNB remains rarely used in the United States.