Neck dissection field and lymph node density predict prognosis in patients with oral cavity cancer and pathological node metastases treated with adjuvant therapy
Neck dissection field and lymph node density predict prognosis in patients with oral cavity cancer and pathological node metastases treated with adjuvant therapy
复制标题
DOI：
10.1016/j.oraloncology.2011.10.017
复制
发表时间：
2012-04-01
期刊：
影响因子：
4.8
通讯作者：
Yen, Tzu-Chen
中科院分区：
文献类型：
--
作者：
Liao, Chun-Ta;Hsueh, Chuen;Yen, Tzu-Chen
病理淋巴结转移（pN+）是口腔鳞状细胞癌（OSCC）的一个确定的预后因素。我们回顾性研究了淋巴结（LN）密度对pN+ OSCC患者进行颈部清扫（ND）和术后辅助治疗的预后意义。我们检查了309名接受I-III级ND治疗的pN+患者和148名接受I-V级ND治疗的pN+患者。5年控制率和生存率是主要的结局指标。I-III级和I-V级NDs患者的5年发生率分别为：局部对照，79%,74% (p = 0.0630)；颈部对照组，81%,68% (p = 0.0014)；远处转移21%，36% (p = 0.0003)；无病生存率（DFS）分别为59%和43% (p = 0.0001)；疾病特异性生存率（DSS）分别为66%和46% (p < 0.0001)；总生存率（OS）分别为49%、37% （p = 0.0048）。多因素分析显示，LN密度>= 0.16是I-III级ND患者5年颈部控制的独立预后因素（所有数据均以p表示，风险比[95%置信区间]）（0.003,2.691[1.412-5.128]）、远处转移（0.001,2.831[1.520-5.270]）、DFS（< 0.001, 2.464[1.571-3.866]）和DSS（0.036, 1.781[1.040-3.052]）。LN密度>= 0.048是I-V级ND患者5年局部控制（0.004,4.871[1.654-14.344]）、颈部控制（0.002,24.738[3.367-181.771]）、DFS（< 0.001, 4.151[2.264-7.610]）、DSS（< 0.001, 3.791[2.017-7.125]）和OS（< 0.001, 2.806[1.706-4.613]）的独立预测因子。我们的研究结果表明LN密度对指导接受辅助治疗的OSCC患者的治疗策略具有预后价值。(C) 2011 Elsevier Ltd.版权所有。
Pathological lymph node metastases (pN+) are an established prognostic factor in oral cavity squamous cell carcinoma (OSCC). We retrospectively examined the prognostic significance of lymph node (LN) density in pN+ OSCC patients who underwent neck dissection (ND) and postoperative adjuvant therapy.We examined 309 pN+ patients who underwent levels I-III ND and 148 pN+ patients treated with levels I-V ND.The 5-year control and survival rates served as the main outcome measures. The 5-year rates for patients treated with levels I-III and I-V NDs were as follows: local control, 79%, 74% (p = 0.0630); neck control, 81%, 68% (p = 0.0014); distant metastasis, 21%, 36% (p = 0.0003); disease-free survival (DFS), 59%, 43% (p = 0.0001); disease-specific survival (DSS), 66%, 46% (p < 0.0001); and overall survival (OS), 49%, 37% (p = 0.0048), respectively. Multivariate analysis demonstrated that an LN density >= 0.16 was an independent prognostic factor for 5-year neck control (all data presented as p, hazard ratio [95% confidence interval]) (0.003, 2.691 [1.412-5.128]), distant metastases (0.001, 2.831 [1.520-5.270]), DFS (< 0.001, 2.464 [1.571-3.866]), and DSS (0.036, 1.781 [1.040-3.052]) in levels I-III ND patients. An LN density >= 0.048 was an independent predictor of 5-year local control (0.004, 4.871 [1.654-14.344]), neck control (0.002, 24.738 [3.367-181.771]), DFS (< 0.001, 4.151 [2.264-7.610]), DSS (< 0.001, 3.791 [2.017-7.125]), and OS (< 0.001, 2.806 [1.706-4.613]) in levels I-V ND patients.Our findings demonstrate the prognostic value of LN density for guiding treatment strategies in OSCC patients who are to receive adjuvant therapy. (C) 2011 Elsevier Ltd. All rights reserved.