Outcome of patients with early stage oral cancer managed by an observation strategy towards the N0 neck using ultrasound guided fine needle aspiration cytology: No survival difference as compared to elective neck dissection
Outcome of patients with early stage oral cancer managed by an observation strategy towards the N0 neck using ultrasound guided fine needle aspiration cytology: No survival difference as compared to elective neck dissection
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DOI：
10.1016/j.oraloncology.2012.08.006
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发表时间：
2013-02-01
期刊：
影响因子：
4.8
通讯作者：
Leemans, C. Rene
中科院分区：
文献类型：
--
作者：
Flach, Geke B.;Tenhagen, Mark;Leemans, C. Rene
目的：口腔癌患者临床N 0颈的处理仍存在争议。我们描述的结果T1-T2口腔癌和N 0颈部超声引导下细针穿刺细胞学（USgFNAC）的基础上，经口切除治疗，然后由一个'等待和扫描'政策（W&S）的患者和方法：这种回顾性分析包括285例连续患者，其中234个W&S和51进行了择期颈淋巴结清扫术（END）。结果：W&S患者的5年疾病特异性生存率（DSS）和总生存率（OS）分别为94.2%和81.6%。在随访期间，72.2%的患者保持无淋巴结转移，27.8%的患者发生迟发转移。W&S延迟转移患者的5年DSS和OS分别为80.0%和62.8%。在END阳性的患者中，这些比率分别为81.3%和64.2%。两组之间的存活率没有显著差异。W&S患者的延迟转移，90.6%需要辅助放疗与55.0%的患者阳性END.Conclusion：关于生存，在早期口腔癌和cN 0颈部的患者的“等待和扫描”的政策，使用严格的USgFNAC监测是合理的，因为生存没有负面影响。采用“等待和扫描”的随访策略，而不是选择性颈部治疗，可以避免不必要的颈淋巴结清扫术及其伴随的发病率在72.2%的患者。然而，对于小部分延迟转移的患者，需要更广泛的辅助放疗治疗。(C)2012爱思唯尔有限公司版权所有。
Objectives: Management of the clinically N0 neck in oral cancer patients remains controversial. We describe the outcome of patients with T1-T2 oral cancer and N0 neck based on ultrasound guided fine needle aspiration cytology (USgFNAC) who were treated by transoral excision and followed by a 'wait and scan' policy (W&S).Patients and methods: This retrospective analysis included 285 consecutive patients of whom 234 were followed by W&S and 51 underwent elective neck dissection (END). Survival rates were compared between groups and correction for confounding factors was performed.Results: Of W&S patients, the 5-year disease-specific (DSS) and overall survival (OS) were 94.2% and 81.6% respectively. During follow-up 72.2% remained free of lymph node metastases and 27.8% developed delayed metastases. W&S patients with delayed metastases had a 5-year DSS and OS of 80.0% and 62.8%, respectively. In patients with positive END these rates were 81.3% and 64.2%, respectively. Between the groups, survival rates were not significantly different. Of the W&S patients with delayed metastases, 90.6% needed adjuvant radiotherapy versus 55.0% of patients with positive END.Conclusion: With regard to survival, in patients with early stage oral cancer and cN0 neck a 'wait and scan' policy using strict USgFNAC surveillance is justified as survival is not negatively influenced. Using a 'wait and scan' follow-up strategy instead of elective neck treatment, unnecessary neck dissection and its accompanying morbidity can be avoided in 72.2% of patients. However, for the small proportion of patients with delayed metastases, more extensive treatment with adjuvant radiotherapy is needed. (C) 2012 Elsevier Ltd. All rights reserved.