Metastatic Lymph Node Burden and Survival in Oral Cavity Cancer
Metastatic Lymph Node Burden and Survival in Oral Cavity Cancer
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DOI：
10.1200/jco.2016.71.1176
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发表时间：
2017-11-01
影响因子：
45.3
通讯作者：
Zumsteg, Zachary S.
中科院分区：
文献类型：
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作者：
Ho, Allen S.;Kim, Sungjin;Zumsteg, Zachary S.
目的目前口腔癌的分期系统包括淋巴结（LN）大小和偏侧性，但对阳性转移淋巴结总数的重视程度较低。我们调查了独立的影响，数值转移LN的负担对survival.MethodsAdult口腔鳞状细胞癌患者进行前期手术切除根治性的意图，确定在2004年和2013年之间的国家癌症数据库。需要进行至少10个LN的颈清扫术。构建多变量模型，以评估转移淋巴结的数量和生存之间的关联，调整因素，如淋巴结的大小，偏侧性，endodal扩展，边缘状态，和辅助treatment.ResultsOverall，14,554例患者符合纳入标准（7,906 N 0患者，6,648淋巴结阳性患者）。随着转移淋巴结数量的增加，死亡风险持续升高，无平台期，最多4个淋巴结的影响最明显（HR，1.34; 95%CI，1.29 - 1.39; P <0.001）。结外侵犯（HR，1.41; 95% CI，1.20至1.65; P < .001）和下颈部受累（HR，1.16; 95% CI，1.06至1.27; P <.001）。001)也预示着死亡率的增加。增加检查的淋巴结数量与生存率的提高相关，在35个淋巴结时达到稳定（HR，0.98; 95%CI，0.98 - 0.99; P <0.001）。在考虑转移性淋巴结数量的多变量模型中，对侧淋巴结受累（N2 c状态）和淋巴结大小与死亡率无关。一种新的节点分期系统递归分区分析比美国联合委员会癌症（第8版）system.ConclusionThe转移性淋巴结的数量是一个重要的预测口腔癌死亡率，黯然失色的其他功能，如LN的大小和contralaterality的预后价值。更稳健的纳入数值转移性LN负荷可能会增加分期，并更好地为辅助治疗决策提供信息。(C)2017年美国临床肿瘤学会
PurposeCurrent staging systems for oral cavity cancers incorporate lymph node (LN) size and laterality, but place less weight on the total number of positive metastatic nodes. We investigated the independent impact of numerical metastatic LN burden on survival.MethodsAdult patients with oral cavity squamous cell carcinoma undergoing upfront surgical resection for curative intent were identified in the National Cancer Data Base between 2004 and 2013. A neck dissection of a minimum of 10 LNs was required. Multivariable models were constructed to assess the association between the number of metastatic LNs and survival, adjusting for factors such as nodal size, laterality, extranodal extension, margin status, and adjuvant treatment.ResultsOverall, 14,554 patients met inclusion criteria (7,906 N0 patients; 6,648 node-positive patients). Mortality risk escalated continuously with increasing number of metastatic nodes without plateau, with the effect most pronounced with up to four LNs (HR, 1.34; 95% CI, 1.29 to 1.39; P < .001). Extranodal extension (HR, 1.41; 95% CI, 1.20 to 1.65; P < .001) and lower neck involvement (HR, 1.16; 95% CI, 1.06 to 1.27; P < . 001) also predicted increased mortality. Increasing number of nodes examined was associated with improved survival, plateauing at 35 LNs (HR, 0.98; 95% CI, 0.98 to 0.99; P < .001). In multivariable models accounting for the number of metastatic nodes, contralateral LN involvement (N2c status) and LN size were not associated with mortality. A novel nodal staging system derived by recursive partitioning analysis exhibited greater concordance than the American Joint Committee on Cancer (8th edition) system.ConclusionThe number of metastatic nodes is a critical predictor of oral cavity cancer mortality, eclipsing other features such as LN size and contralaterality in prognostic value. More robust incorporation of numerical metastatic LN burden may augment staging and better inform adjuvant treatment decisions. (C) 2017 by American Society of Clinical Oncology