Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma - Implications for therapeutic decision making
Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma - Implications for therapeutic decision making
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DOI：
10.1002/cncr.11526
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发表时间：
2003-08-01
期刊：
影响因子：
6.2
通讯作者：
Myers, JN
中科院分区：
文献类型：
--
作者：
Greenberg, JS;El Naggar, AK;Myers, JN
背景区域淋巴结转移是口腔舌鳞状细胞癌（SCCOT）患者治疗结局的最可靠预测因素。最近美国癌症联合委员会对恶性黑色素瘤分期的更新已纳入病理淋巴结分期。作者假设病理淋巴结分期（pN）比临床淋巴结分期（cN）更能预测治疗结果。作者回顾性分析了1980年1月至1995年12月期间接受SCCOT初次手术治疗（包括颈淋巴结清扫术）的266例患者。根据临床和病理淋巴结分期比较总体和疾病特异性生存期以及无病期。临床（cN 0-cN2）和病理淋巴结分期（pN 0-pN 2）的生存率差异具有统计学意义。但病理淋巴结分期的生存率和无病期差异（P < 0.0001）高于临床淋巴结分期（P < 0.002）。这种差异可以用阶段迁移来解释（即，与没有cN 0 - 1疾病的患者相比，cN 0 -1疾病的患者在病理检查时具有更晚期的淋巴结分期）。作者发现cN 0组中隐匿性淋巴结疾病的发生率为34%（19%的隐匿性淋巴结有囊外扩散[ECS]）。同样，43%的cN 1患者的分期高于pN 2b疾病，50%的患者患有ECS。对于接受SCCOT治疗的患者，应考虑根据分期或治疗性颈淋巴结清扫术进行病理淋巴结分期，以识别可能从额外辅助治疗中获益的高危患者。在将病理淋巴结分期纳入标准分期标准之前，前瞻性研究对验证这些结果至关重要。(C)2003年美国癌症协会。
BACKGROUND. Regional lymph node metastasis is the most reliable predictor of treatment outcomes for patients with squamous cell carcinoma of the oral tongue (SCCOT). A recent American Joint Committee on Cancer staging update of malignant melanoma has incorporated pathologic lymph node staging. The authors hypothesized that pathologic lymph node staging (pN) would be a more reliable predictor of treatment outcomes than clinical lymph node staging (cN).METHODS. The authors retrospectively reviewed 266 patients who received primary surgical treatment for SCCOT, including a neck dissection, from January 1980 to December 1995. Overall and disease-specific survival and disease-free interval were compared with respect to clinical and pathologic lymph node stages.RESULTS. Statistically significant survival differences were identified for both clinical (cN0-cN2) and pathologic lymph node stages (pN0-pN2). However, survival and disease-free interval differences for pathologic lymph node staging reached higher statistical significance (P < 0.0001) than for clinical lymph node staging (P < 0.002). This disparity can be explained by stage migration (i.e., patients with cN0-1 disease have a more advanced lymph node stage at the time of pathologic review compared with patients without cN0-1 disease). The authors found a 34% rate Of Occult lymph node disease in the cN0 group (19% of occult lymph nodes had extracapsular spread [ECS]). Similarly, 43% of cN1 patients had a higher stage than pN2b disease and 50% had ECS.CONCLUSIONS. Pathologic lymph node staging, based on a staging or therapeutic neck dissection, should be considered for patients treated for SCCOT to identify high-risk patients who may benefit from additional adjuvant therapy. Prospective studies are essential to validate these findings before pathologic lymph node staging is included in standard staging criteria. (C) 2003 American Cancer Society.