When Should Elective Neck Dissection Be Considered for Early-Stage Oral Cavity Tumors? Insights From a Multicenter Study of 1109 Patients and Development of a Multiparametric Predictive Model.

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-10-13 DOI:10.1002/hed.70064

Luca Calabrese, Monir Abousiam, Marta Tagliabue, Marco Ferrari, Rita De Berardinis, Gerardo Petruzzi, Francesco Mazzola, Alberto Grammatica, Davide Mattavelli, Remo Accorona, Alberto Vito Marcuzzo, Pierre Guarino, Francesco Mattioli, Alessia Rubini, Matteo Fermi, Andrea Sacchetto, Elisa Laura, Riccardo Nocini, Fabiola Incandela, Pietro De Luca, Andrea Iandelli, Filippo Marchi, Mario Turri Zanoni, Leone Giordano, Andrea Galli, Simone Mauramati, Virginia Corazzi, Chiara Bianchini, Mario Ciniglio Appiani, Matteo Garotta, Maria Silvia Lazio, Domenico Michele Modica, Salvatore Poma, Martina Renna, Annalisa Tosi, Melania Franco, Davide Di Santo, Giulia Togo, Paola Stritoni, Cecilia Albi, Ilaria Girolami, Enrico Fazio, Fabrizio Russo, Daniele Spada, Angela Gasparini, Virginia Dallari, Sara Bassani, Bianca Maria Festa, Dario Gregori, Carlotta Borghini, Gloria Brigiari, Francesca Angioletti, Alessandra Sordi, Milena Fior, Alessandra Ruaro, Valero Arietti, Giulia Gobbo, Francesco Uderzo, Rossana Bussani, Maurizio Pinamonti, Giuseppe Maruccio, Guglielmo Ronzani, Elisa Castelluccio, Pasquale d'Alessio, Daria Salsi, Roberto Di Carlo, Stefano Pelucchi, Giuseppe Bertolini, Massimo Ducci, Alberto Dragonetti, Mario Galfano, Franco Ionna, Doriano Politi, Roberto Saetti, Vincenzo Saita, Antonio Sarno, Giandomenico Maggiore, Angelo Camaioni, Luca De Campora, Luca Sacchetto, Paolo Castelnuovo, Marco Radici, Claudio Donadio Caporale, Domenico Cuda, Alberto Deganello, Andy Bertolin, Marco Benazzo, Giorgio Peretti, Mario Bussi, Daniele Marchioni, Livio Presutti, Giancarlo Tirelli, Mohssen Ansarin, Cesare Piazza, Piero Nicolai, Raul Pellini, Gabriele Molteni, Luca Gazzini

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引用次数: 0

Abstract

Background: Nodal metastases significantly affect prognosis in oral cavity squamous cell carcinoma (OCSCC). In early-stage OCSCC (cT1-T2 cN0), management of the clinically negative neck (cN0) remains controversial. Depth of invasion (DOI) is a key determinant for END, but other histopathological parameters, such as grading, perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion (WPOI), are emerging prognostic factors.

Methods: This multicenter retrospective study analyzed 1109 patients with cT1-T2 cN0 OCSCC treated at 30 Italian hospitals since 2017. Data on histopathological parameters, tumor characteristics, and patient outcomes were collected via the REDCap platform. Simple and multivariable logistic regression models were developed to assess predictors of occult nodal metastases.

Results: A total of 585 patients were clinically classified as cT1 tumors (53%), 503 as cT2 (45%), and cTis (1.9%). Of the 1109 patients, 193 (28%) had occult nodal metastases, with DOI, LVI, PNI, WPOI, and grading emerging as significant predictors. A predictive model integrating these variables demonstrated superior accuracy compared to a DOI-only model (AUROC comparison, p < 0.01).

Conclusion: This study highlights the importance of incorporating multiple histopathological parameters into risk models for occult nodal metastases, overcoming the fixed DOI as a cutoff. The proposed predictive model offers a more precise method for guiding END in early-stage OCSCC, allowing individualized risk estimation.

查看原文本刊更多论文

早期口腔肿瘤何时应考虑择期颈部清扫？来自1109名患者的多中心研究的见解和多参数预测模型的发展。

背景：结转移对口腔鳞状细胞癌（OCSCC）的预后有显著影响。在早期OCSCC （cT1-T2 cN0）中，临床阴性颈部（cN0）的处理仍然存在争议。侵袭深度（DOI）是END的关键决定因素，但其他组织病理学参数，如分级、神经周围侵袭（PNI）、淋巴血管侵袭（LVI）和最坏侵袭模式（WPOI），是新兴的预后因素。方法：本多中心回顾性研究分析了2017年以来在意大利30家医院治疗的1109例cT1-T2 cN0 OCSCC患者。通过REDCap平台收集组织病理学参数、肿瘤特征和患者预后的数据。建立了简单和多变量logistic回归模型来评估隐匿性淋巴结转移的预测因素。结果：临床分类为cT1肿瘤585例（53%），cT2肿瘤503例（45%），cTis肿瘤（1.9%）。在1109例患者中，193例（28%）有隐匿性淋巴结转移，DOI、LVI、PNI、WPOI和分级成为重要的预测因素。与仅使用DOI的模型相比，整合这些变量的预测模型显示出更高的准确性（AUROC比较）。结论：本研究强调了将多种组织病理学参数纳入隐匿性淋巴结转移风险模型的重要性，克服了固定DOI作为截止点的影响。提出的预测模型为指导早期OCSCC的END提供了更精确的方法，可以进行个性化的风险评估。

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

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.