Inclusion of Extracapsular Spread in the pTNM Classification System A Proposal for Patients With Head and Neck Carcinoma
Inclusion of Extracapsular Spread in the pTNM Classification System A Proposal for Patients With Head and Neck Carcinoma
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DOI：
10.1001/jamaoto.2013.2666
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发表时间：
2013-05-01
影响因子：
7.8
通讯作者：
Leon, Xavier
中科院分区：
文献类型：
--
作者：
de Juan, Julia;Garcia, Jacinto;Leon, Xavier
重要性：在颈淋巴结清扫术中纳入颈淋巴结转移伴囊外淋巴结转移（ECS）的数据可改善头颈部鳞状细胞癌（HNSCC）患者的预后分类。目的：评估ECS在HNSCC患者中的预后能力，并分析将此信息纳入颈淋巴结清扫术患者病理分类的有用性。设计：从1985年至2007年进行的回顾性单中心研究。设置：三级转诊中心。参与者：共1190例接受颈淋巴结清扫术的HNSCC患者。干预：单侧或双侧颈淋巴结清扫术。主要结局和指标：校正生存率和局部、区域和远处无瘤生存率。根据递归分割分析（RPA）方法对患者进行分类，将pN分类和ECS颈部淋巴结数量作为自变量。颈清扫术中无转移淋巴结的患者（pN 0）的5年校正生存率为85.5%，颈淋巴结转移但无ECS的患者为85.5%。（pN+/ECS-）为62.5%，颈淋巴结转移伴ECS（pN+/ECS+）为29.9%。pN 0病变组与pN +/ECS-组的生存率差异有统计学意义（P
Importance: The inclusion of data about the presence of metastatic neck nodes with extracapsular spread (ECS) in the neck dissection improves the prognostic classification of patients with head and neck squamous cell carcinoma (HNSCC).Objective: To evaluate the prognostic capacity of ECS in patients with HNSCC, and to analyze the usefulness of including this information in the pathological classification of patients treated with a neck dissection.Design: Retrospective unicenter study performed from 1985 through 2007.Setting: Tertiary referral center.Participants: A total of 1190 patients with HNSCC treated with a neck dissection.Intervention: Unilateral or bilateral neck dissection.Main Outcomes and Measures: Adjusted survival and local, regional, and distant metastases-free survival. Patients were classified according to a recursive partitioning analysis (RPA) method, considering pN cat-egory and number of neck nodes with ECS as the independent variables.Results: Five-year adjusted survival for patients without metastatic nodes in the neck dissection (pN0) was 85.5%, for patients with neck node metastases without ECS (pN+/ECS-) it was 62.5%, and for patients with neck node metastases with ECS (pN+/ECS+) it was 29.9%. There were significant differences in survival between patients with pN0 lesions and pN +/ECS- (P