Nodal Metastasis in Surgically Treated Oral Cavity Squamous Cell Carcinoma.

IF 2 4区医学 Q2 OTORHINOLARYNGOLOGY

Orl-Journal for Oto-Rhino-Laryngology Head and Neck Surgery Pub Date : 2023-01-01 Epub Date: 2023-11-15 DOI:10.1159/000534491

Ryan M Carey, Vincent J Anagnos, Aman Prasad, Neel R Sangal, Karthik Rajasekaran, Rabie M Shanti, Steven B Cannady, Jason G Newman, Jason A Brant, Robert M Brody

{"title":"Nodal Metastasis in Surgically Treated Oral Cavity Squamous Cell Carcinoma.","authors":"Ryan M Carey, Vincent J Anagnos, Aman Prasad, Neel R Sangal, Karthik Rajasekaran, Rabie M Shanti, Steven B Cannady, Jason G Newman, Jason A Brant, Robert M Brody","doi":"10.1159/000534491","DOIUrl":null,"url":null,"abstract":"Introduction: Management of the neck in oral cavity squamous cell carcinoma (OCSCC) is essential to oncologic control and survival. The rates of lymph node metastasis (LNM) vary based on oral cavity tumor site and stage and influence treatment decisions. The aim of this paper was to describe clinical LNM for different tumor subsites and stages of surgically managed OCSCC.Methods: We conducted a retrospective analysis of 25,846 surgically managed OCSCC patients from the National Cancer Database (NCDB) stratified by tumor subsite and clinical T-stage. For cN + patients, rates of pathologic LNM and absence of pathologic LNM were determined. For cN0 patients, outcomes included the rates of elective neck dissection (END) and occult LNM and predictors of occult LNM determined by a multivariable logistic regression model.Results: A total of 25,846 patients (59.1% male, mean age 61.9 years) met inclusion criteria with primary tumor sites including oral tongue (50.8%), floor of mouth (21.2%), lower alveolus (7.6%), buccal mucosa (6.7%), retromolar area (4.9%), upper alveolus (3.6%), hard palate (2.7%), and mucosal lip (2.5%). Among all sites, clinical N+ rates increased with T-stage (8.9% T1, 28.0% T2, 51.6% T3, 52.5% T4); these trends were preserved across subsites. Among patients with cN + disease, the overall rate of concordant positive pathologic LNM was 80.1% and the rate of discordant negative pathologic LNM was 19.6%, which varied based on tumor site and stage. In the overall cohort of cN0 patients, 59.9% received END, and the percentage of patients receiving END increased with higher tumor stage. Occult LNM among those cN0 was found in 25.1% of END cases, with the highest rates in retromolar (28.8%) and oral tongue (27.5%) tumors. Multivariable regression demonstrated significantly increased rates of occult LNM for higher T stage (T2 OR: 2.1 [1.9-2.4]; T3 OR: 3.0 [2.5-3.7]; T4 OR: 2.7 [2.2-3.2]), positive margins (OR: 1.4 [1.2-1.7]), and positive lymphovascular invasion (OR: 5.1 [4.4-5.8]).Conclusions: Management of the neck in OCSCC should be tailored based on primary tumor factors and considered for early-stage tumors.","PeriodicalId":49717,"journal":{"name":"Orl-Journal for Oto-Rhino-Laryngology Head and Neck Surgery","volume":"85 6","pages":"348-359"},"PeriodicalIF":2.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10652645/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orl-Journal for Oto-Rhino-Laryngology Head and Neck Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000534491","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/15 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Management of the neck in oral cavity squamous cell carcinoma (OCSCC) is essential to oncologic control and survival. The rates of lymph node metastasis (LNM) vary based on oral cavity tumor site and stage and influence treatment decisions. The aim of this paper was to describe clinical LNM for different tumor subsites and stages of surgically managed OCSCC.

Methods: We conducted a retrospective analysis of 25,846 surgically managed OCSCC patients from the National Cancer Database (NCDB) stratified by tumor subsite and clinical T-stage. For cN + patients, rates of pathologic LNM and absence of pathologic LNM were determined. For cN0 patients, outcomes included the rates of elective neck dissection (END) and occult LNM and predictors of occult LNM determined by a multivariable logistic regression model.

Results: A total of 25,846 patients (59.1% male, mean age 61.9 years) met inclusion criteria with primary tumor sites including oral tongue (50.8%), floor of mouth (21.2%), lower alveolus (7.6%), buccal mucosa (6.7%), retromolar area (4.9%), upper alveolus (3.6%), hard palate (2.7%), and mucosal lip (2.5%). Among all sites, clinical N+ rates increased with T-stage (8.9% T1, 28.0% T2, 51.6% T3, 52.5% T4); these trends were preserved across subsites. Among patients with cN + disease, the overall rate of concordant positive pathologic LNM was 80.1% and the rate of discordant negative pathologic LNM was 19.6%, which varied based on tumor site and stage. In the overall cohort of cN0 patients, 59.9% received END, and the percentage of patients receiving END increased with higher tumor stage. Occult LNM among those cN0 was found in 25.1% of END cases, with the highest rates in retromolar (28.8%) and oral tongue (27.5%) tumors. Multivariable regression demonstrated significantly increased rates of occult LNM for higher T stage (T2 OR: 2.1 [1.9-2.4]; T3 OR: 3.0 [2.5-3.7]; T4 OR: 2.7 [2.2-3.2]), positive margins (OR: 1.4 [1.2-1.7]), and positive lymphovascular invasion (OR: 5.1 [4.4-5.8]).

Conclusions: Management of the neck in OCSCC should be tailored based on primary tumor factors and considered for early-stage tumors.

查看原文本刊更多论文

手术治疗口腔鳞状细胞癌的淋巴结转移。

口腔鳞状细胞癌(OCSCC)的颈部管理对肿瘤控制和生存至关重要。淋巴结转移(LNM)率根据口腔肿瘤的部位和分期而变化，并影响治疗决策。本文的目的是描述手术治疗的OCSCC的不同肿瘤亚位和分期的临床LNM。方法:我们对来自国家癌症数据库(NCDB)的25,846例手术治疗的OCSCC患者进行了回顾性分析，按肿瘤亚位点和临床t分期分层。对于cN +患者，测定病理性LNM的发生率和不存在病理性LNM的发生率。对于cN0患者，结果包括选择性颈部清扫(END)和隐匿性LNM的发生率，以及由多变量logistic回归模型确定的隐匿性LNM的预测因子。结果:25846例患者(男性59.1%，平均年龄61.9岁)符合纳入标准，原发肿瘤部位包括口腔舌(50.8%)、口腔底(21.2%)、下牙槽(7.6%)、颊黏膜(6.7%)、磨牙后区(4.9%)、上牙槽(3.6%)、硬腭(2.7%)和粘膜唇(2.5%)。各部位临床N+率随t期升高(T1为8.9%，T2为28.0%，T3为51.6%，T4为52.5%);这些趋势在各个子点上都得到了保留。在cN +疾病患者中，总体病理LNM一致阳性率为80.1%，病理LNM不一致阴性率为19.6%，不同肿瘤部位和分期差异较大。在cN0患者的总队列中，59.9%的患者接受了END，并且随着肿瘤分期的增加，接受END的患者比例也在增加。隐匿性LNM发生率为25.1%，其中以臼齿后肿瘤(28.8%)和口腔舌部肿瘤(27.5%)最高。多变量回归显示，高T期隐匿性LNM发生率显著增加(T2 OR: 2.1 [1.9-2.4];T3或:3.0 [2.5-3.7];T4 OR: 2.7[2.2-3.2])，边缘阳性(OR: 1.4[1.2-1.7])，淋巴血管浸润阳性(OR: 5.1[4.4-5.8])。结论:颈部OCSCC的治疗应根据原发肿瘤因素进行定制，并考虑早期肿瘤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Orl-Journal for Oto-Rhino-Laryngology Head and Neck Surgery 医学-耳鼻喉科学

CiteScore

2.80

自引率

7.70%

发文量

审稿时长

6-12 weeks

期刊介绍： ''ORL'' contains concise, original scientific papers of interest for both clinicians and researchers in oto-rhino-laryngology and head and neck surgery. Contributions drawn from the basic sciences cover new knowledge on the anatomy, pathology, pathophysiology, immunology and tumor biology of head and neck and the auditory and vestibular system, the salivary glands, paranasal sinuses and of the organs of the upper respiratory and digestive tract. The practical value of the journal is accentuated by reports of clinical progress in diagnosis and therapy.