Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience

Elective Neck Dissection or Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer Patients: The Dutch Experience
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DOI：
10.3390/cancers12071783
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发表时间：
2020-07-01
期刊：
CANCERS
影响因子：
5.2
通讯作者：
de Bree, Remco
de Bree, Remco
中科院分区：
医学2区
文献类型：
--
作者：
den Toom, Inne J.;Boeve, Koos;de Bree, Remco

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背景：前哨淋巴结活检(SLNB)已被引入作为早期口腔癌患者隐匿性转移的诊断分期方法。关于精确度与常规使用的选择性颈清扫术的比较(完)，文献中缺乏。方法：采用回顾性多中心队列研究，包括390例END分期的患者和488例SLNB分期的患者。结果：END和SLNB患者的总体敏感性(84%vs.81%，p=0.612)和阴性预测值(93%，p=1.000)相当。与SLNb组(23%)相比，结束队列包含更多的pt2肿瘤(51%)(p&lt；0.001)。以PT分期划分的SLNB和END的敏感性和NPV差异无统计学意义。在口底肿瘤中，与END相比，SLNB的敏感性(63%对92%，p=0.006)和NPV(90%对97%，p=0.057)较低。与PT1终末期患者相比，PT1SLNB患者的疾病特异性存活率(DSS)更高(96%比90%，p=0.048)。结论：在缺乏随机临床试验的情况下，本研究提供了可获得的最高证据，证明在口腔癌中，除口底肿瘤外，SLNB在检测隐匿性淋巴结转移方面与END一样准确。
Background: Sentinel lymph node biopsy (SLNB) has been introduced as a diagnostic staging modality for detection of occult metastases in patients with early stage oral cancer. Comparisons regarding accuracy to the routinely used elective neck dissection (END) are lacking in literature. Methods: A retrospective, multicenter cohort study included 390 patients staged by END and 488 by SLNB. Results: The overall sensitivity (84% vs. 81%,p= 0.612) and negative predictive value (NPV) (93%,p= 1.000) were comparable between END and SLNB patients. The END cohort contained more pT2 tumours (51%) compared to the SLNB cohort (23%) (p< 0.001). No differences were found for sensitivity and NPV between SLNB and END divided by pT stage. In floor-of-mouth (FOM) tumours, SLNB had a lower sensitivity (63% vs. 92%,p= 0.006) and NPV (90% vs. 97%,p= 0.057) compared to END. Higher disease-specific survival (DSS) rates were found for pT1 SLNB patients compared to pT1 END patients (96% vs. 90%,p= 0.048). Conclusion: In the absence of randomized clinical trials, this study provides the highest available evidence that, in oral cancer, SLNB is as accurate as END in detecting occult lymph node metastases, except for floor-of-mouth tumours.