The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas
The role of initial neck dissection for patients with node-positive oropharyngeal squamous cell carcinomas
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初次颈清扫术对淋巴结阳性口咽鳞状细胞癌患者的作用
DOI：
10.1016/j.oraloncology.2014.03.003
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发表时间：
2014
期刊：
影响因子：
4.8
通讯作者：
M. Fuji
中科院分区：
文献类型：
--
作者：
T. Sakashita;A. Homma;R. Hayashi;K. Kawabata;K. Yoshino;S. Iwae;Y. Hasegawa;K. Nibu;T. Kato;K. Shiga;K. Matsuura;N. Monden;M. Fuji
BackgroundThe目前的研究旨在评估的作用，初步颈清扫术（ND）的患者与淋巴结阳性的口咽鳞状细胞癌（OPSCC）。MethodsThe数据为202例患者，以前未经治疗的淋巴结阳性OPSCC收集了12个机构属于头颈部癌症研究组在日本临床肿瘤学组。这些患者被分为两组，由初始ND组和等待和观望组，根据治疗policy.ResultsRegional复发观察到17的93例患者进行初始ND，而，复发或持续性疾病观察到40的109例患者谁没有进行初始ND。观察组和初始ND组的4年总生存率（OS）分别为74.0%和78.7%，各组的4年区域控制率（RC）分别为77.6%和84.9%。OS或RC无显著差异（分别为p= 0.3440和p = 0.2382）。然而，对于N3疾病患者，初始ND组的4年OS（100%）是有利的。对于N2a疾病患者，初始ND组的4年RC显著高于等待观察组（100%vs62.5%，p = 0.0156）。当确定性放疗或放化疗后的淋巴结评估充分应用时，不涉及初始ND的治疗策略被认为是可行和可接受的。然而，初始ND可能改善可切除的大体积淋巴结疾病患者的预后。
BackgroundThe current study sought to assess the role of initial neck dissection (ND) for patients with node-positive oropharyngeal squamous cell carcinomas (OPSCC).MethodsThe data for 202 patients with previously untreated node-positive OPSCC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group. These patients were categorized into two groups, consisting of the initial ND group and the wait-and-see group, according to treatment policy.ResultsRegional recurrence was observed in 17 of 93 patients undergoing initial ND, whereas, recurrent or persistent diseases were observed in 40 of 109 patients who did not undergo initial ND. The 4-year overall survival rates (OS) for the wait-and-see group and initial ND groups were 74.0% and 78.7%, respectively, and the 4-year regional control rates (RC) for each group were 77.6% and 84.9%. There were no significant differences in either OS or RC (p= 0.3440 andp= 0.2382, respectively). However, for patients with N3 disease, the 4-year OS of the initial ND group (100%) was favorable. For patients with N2a disease, the 4-year RC of the initial ND group was higher than that of the wait-and-see group statistically (100% vs 62.5%,p= 0.0156).ConclusionsThe role of initial ND was limited in patients with node-positive OPSCC. The treatment strategy not involving initial ND is considered feasible and acceptable when nodal evaluation after definitive radiotherapy or chemoradiotherapy is applied adequately. However, it is possible that initial ND improves outcomes in patients with resectable large-volume nodal disease.