Prognostic significance of extranodal extension in head and neck squamous cell carcinoma cNO patients with occult metastatic neck nodes
Prognostic significance of extranodal extension in head and neck squamous cell carcinoma cNO patients with occult metastatic neck nodes
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DOI：
10.1016/j.otorri.2017.07.002
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发表时间：
2018-05-01
影响因子：
1
通讯作者：
Leon, Xavier
中科院分区：
文献类型：
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作者：
Lop, Joan;Rigo, Antoni;Leon, Xavier
前言和目的：在头颈部鳞状细胞癌患者中，结外转移是一个独立的不良预后因素。材料和方法：我们回顾分析了348例头颈部鳞状细胞癌患者的资料，这些患者在最初的体检中没有任何治疗，也缺乏颈部淋巴结转移的临床或放射学证据，在1992-2014年间接受了选择性颈淋巴清扫术。结果：颈淋巴结隐匿性转移的患者比例为33%。在这些患者中，23.5%的患者至少有一个转移性颈淋巴结并向外延伸。不同颈淋巴结状态患者的疾病特异性存活率有显著差异。无组织病理学转移者的5年生存率为90%，无结外转移的隐性颈淋巴结转移者为71.2%，有结外转移的隐性颈转移者为25.9%(P=0.0001)。多因素分析显示，隐匿性淋巴结转移伴结外转移是对生存率影响最大的因素。在第8版TNM分类中加入了结外扩展作为组织病理学评估的标准，与以前的TNM版本相比，提高了预后能力。结论：在头颈部鳞状细胞癌的初始检查中，出现转移性颈淋巴结并有结外扩展是一个不利的预后因素，在肿瘤的初始检查中没有临床证据。(C)2017年埃尔塞维尔·埃斯帕纳、S.L.U和社会·埃斯帕诺拉·德·奥托里诺拉·阿林格尼亚和西鲁贾·德卡贝扎·库埃洛。版权所有。
Introduction and objectives: Extranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease.Material and methods: We retrospectively analysed data from 348 head and neck squamous cell carcinoma patients without any previous treatment and lacking clinical or radiological evidence of neck node metastases during the initial workup, treated with an elective neck dissection between 1992-2014. The incidence of occult metastatic neck nodes with extranodal extension and the impact of extranodal extension in survival were evaluated.Results: The proportion of patients with occult neck node metastases was 33%. Of these, 23.5% had at least one metastatic neck node with extranodal extension. There were significant differences in the disease-specific survival rate according to neck node status. Five-year disease-specific survival for patients without histopathological metastases was 90%, for patients with occult neck node metastases without extranodal extension it was 71.2%, and for patients with occult neck node metastases with extranodal extension it was 25.9% (P = .0001). The multivariate analysis revealed that the presence of occult node metastases with extranodal extension was the factor with strongest impact on survival. The inclusion of the extranodal extension as a criterion of histopathological evaluation in the 8th TNM classification edition improves the prognostic capacity compared to previous TNM editions.Conclusions: Appearance of metastatic neck nodes with extranodal extension is an adverse prognostic factor in head and neck squamous cell carcinoma patients without clinical evidence of regional disease during the initial workup of the tumour. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. All rights reserved.