Impact of contralateral occult neck metastasis in HPV-associated tonsil cancer: Is elective contralateral neck dissection required?

IF 2.2 3区医学 Q2 Dentistry

Journal of Stomatology Oral and Maxillofacial Surgery Pub Date : 2024-11-07 DOI:10.1016/j.jormas.2024.102140

Geun-Jeon Kim, Jooin Bang, Oh-Hyeong Lee, Sang-Yeon Kim, Dong-Il Sun

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Abstract

Background: Contralateral elective neck dissection in human papillomavirus (HPV)- associated tonsil cancer is a matter of debate.

Objectives: The aim of this study was to analyze rates of contralateral lymph node (LN) metastasis and their prognostic effects on HPV-associated tonsil cancer. We also assessed the necessity of elective contralateral neck dissection.

Methods: To investigate the pathologic incidence of and risk factors for contralateral nodal disease in HPV-associated tonsil cancer treated with upfront primary surgery and bilateral neck dissection, the records of 68 patients were reviewed.

Results: Six (8.8%) patients displayed pathologic contralateral nodal disease; four of the patients had LN metastasis confirmed in contralateral level II, one patient had LN metastasis in level III, and one patient had multi-level metastasis in contralateral levels II and III. Contralateral LN metastasis showed a significant association with greater depth of invasion (DOI) in primary tumor (p = 0.032), count of positive LN (p = 0.008), and positive LN ratio of the ipsilateral neck (p = 0.01). Patients with contralateral LN metastasis showed a significantly worse five-year overall survival but no significant difference in disease-free survival.

Conclusion: HPV-associated tonsil cancer has exceedingly low rates of occult contralateral LN metastasis. However, in cases of ipsilateral multiple node metastases and higher DOI, it may be worth considering elective contralateral neck dissection based on the risk of occult metastasis.

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HPV 相关扁桃体癌对侧隐性颈部转移的影响：是否需要进行选择性对侧颈部切除？

背景：人类乳头瘤病毒（HPV）相关扁桃体癌的对侧选择性颈部切除术是一个争论的问题：人乳头瘤病毒（HPV）相关扁桃体癌的对侧选择性颈部切除术是一个有争议的问题：本研究旨在分析对侧淋巴结（LN）转移率及其对HPV相关扁桃体癌预后的影响。我们还评估了选择性对侧颈部切除的必要性：方法：为了研究采用前期原发手术和双侧颈部切除术治疗的 HPV 相关性扁桃体癌中对侧结节病的病理发生率和风险因素，我们回顾了 68 例患者的病历：结果：6 名患者（8.8%）出现了病理上的对侧结节病；其中 4 名患者的 LN 转移证实发生在对侧 II 层，1 名患者的 LN 转移发生在 III 层，1 名患者的对侧 II 层和 III 层出现了多层次转移。对侧淋巴结转移与原发肿瘤侵犯深度（DOI）（P=0.032）、阳性淋巴结数量（P=0.008）和同侧颈部阳性淋巴结比例（P=0.01）显著相关。有对侧LN转移的患者五年总生存率明显较低，但无病生存率无明显差异：结论：HPV相关性扁桃体癌的隐匿性对侧LN转移率极低。结论：HPV相关性扁桃体癌的隐匿性对侧LN转移率极低，但在同侧多发结节转移和DOI较高的病例中，值得根据隐匿性转移的风险考虑选择性对侧颈部切除。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stomatology Oral and Maxillofacial Surgery Dentistry-Oral Surgery

CiteScore

2.20

自引率

9.10%

发文量

305

期刊介绍： J Stomatol Oral Maxillofac Surg publishes research papers and techniques - (guest) editorials, original articles, reviews, technical notes, case reports, images, letters to the editor, guidelines - dedicated to enhancing surgical expertise in all fields relevant to oral and maxillofacial surgery: from plastic and reconstructive surgery of the face, oral surgery and medicine, … to dentofacial and maxillofacial orthopedics. Original articles include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses. All manuscripts submitted to the journal are subjected to peer review by international experts, and must: Be written in excellent English, clear and easy to understand, precise and concise; Bring new, interesting, valid information - and improve clinical care or guide future research; Be solely the work of the author(s) stated; Not have been previously published elsewhere and not be under consideration by another journal; Be in accordance with the journal''s Guide for Authors'' instructions: manuscripts that fail to comply with these rules may be returned to the authors without being reviewed. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey Platforms.