Distribution pattern and pathologic analysis of metastatic sentinel and non-sentinel lymph nodes in lymphatic basin dissection for clinical T2/T3 oral cancer with clinical N0 status
Distribution pattern and pathologic analysis of metastatic sentinel and non-sentinel lymph nodes in lymphatic basin dissection for clinical T2/T3 oral cancer with clinical N0 status
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临床N0状态的临床T2/T3口腔癌淋巴盆清扫中转移性前哨和非前哨淋巴结的分布模式和病理分析
DOI：
10.1016/j.anl.2021.11.010
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发表时间：
2022
影响因子：
1.7
通讯作者：
Hasegawa Yasuhisa
中科院分区：
文献类型：
--
作者：
Hirakawa Hitoshi;Matsuzuka Takashi;Uemura Hirokazu;Yoshimoto Seiichi;Miura Kouki;Shiotani Akihiro;Sugasawa Masashi;Homma Akihiro;Yokoyama Junkichi;Tsukahara Kiyoaki;Yoshizaki Tomokazu;Hanai Nobuhiro;Suzuki Hidenori;Suzuki Mikio;Hasegawa Yasuhisa
目的探讨ct2/T3cN0口腔鳞状细胞癌(OSCC)前哨淋巴结(SN)和非前哨淋巴结(NSN)在前哨淋巴结(SN)淋巴盆清扫术(SLBD)中的定位特点及病理分析。共有57名患者入选。侧颈分为5个淋巴盆。所有患者均接受SLBD后备选择性颈淋巴清扫术(I-III)联合肿瘤切除。当SNS发现在I-III节段之外，包括对侧颈，SLBD是通过分别移除包含SNS的间隔来进行的。SN转移可分为孤立肿瘤细胞(ITCs)、微转移或大转移。ITC定义为最大直径不大于0.2 mm的病变，分类为pN0。所有转移性淋巴结，包括假阴性病例，均在SN淋巴盆内检出。在调整了其他危险因素后，SN阳性仍然是预测口腔鳞癌患者5年总生存率较差的重要指标。结论SLBD术中SN活检是一种有效的治疗方法，对判断口腔鳞癌的病理淋巴结分期有重要价值。在接受选择性颈清扫术(I-III)的SLBD患者中，SN阳性被证明是预后不良的独立预测因子。
ObjectiveThe localization pattern of metastatic sentinel lymph node (SN) and non-SNs and pathologic analysis of metastatic lymph nodes in SN lymphatic basin dissection (SLBD) were investigated in patients with cT2/T3cN0 oral squamous cell carcinoma (OSCC).MethodsThis prospective multicenter trial involved 10 institutions nationwide in Japan. A total of 57 patients were enrolled. The lateral neck was divided into 5 lymphatic basins. The lymphatic basin containing SNs was defined as the SN lymphatic basin.All patients underwent SLBD with backup selective neck dissection (I-III) combined with primary tumor removal. When SNs were found outside of levels I-III, including in the contralateral neck, SLBD was performed by removing the compartments containing SNs separately. SN metastasis was classified as isolated tumor cells (ITCs), micrometastasis, or macrometastasis. ITCs are defined as a lesion no larger than 0.2 mm in largest dimension and are classified as pN0.ResultsSN metastasis was observed in 22 cases. All metastatic lymph nodes, including false-negative cases, were detected in the SN lymphatic basin. Isolated tumor cells in the SNs did not affect prognosis, whereas micrometastasis tended to have poor prognosis.After adjusting for other risk factors, a positive SN remained a significant predictor of poor 5-year overall survival in pT2-4 OSCC.ConclusionSLBD for intraoperative SN biopsy is a sufficient therapeutic procedure and is valuable for determining pathologic nodal stage in OSCC. SN positivity was demonstrated to be an independent predictor of poor prognosis in patients with pT2-4 disease undergoing SLBD with backup selective neck dissection (I-III).