{"title":"口腔舌鳞状细胞癌淋巴结转移数量的预后意义：SEER数据库和机构登记的人口研究。","authors":"Wenjie Huang, Yu Zhang, Hao Li, Zhiying Liang, Shumin Zhou, Jie Pan, Hui Xie, Chao Luo, Shuqi Li, Guangying Ruan, Fei Ai, Yanfeng Chen","doi":"10.1002/cam4.70493","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>To investigate the impact of the number of positive lymph nodes (PLNs) on long-term survival and pathological nodal stage in patients with oral tongue squamous cell carcinoma (OTSCC).</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>Newly diagnosed and nonmetastatic adult patients with OTSCC who underwent curative resection were identified between January 2010 and December 2020. External validation was performed via the SEER registry. Multivariate Cox proportional hazards model was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of pathological nodal features. Propensity score matching (PSM) was used to assess effect of adjuvant chemoradiotherapy (ACRT).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 518 curative-intent OTSCC patients, the number of PLNs independently predicted overall survival (OS), surpassing other pathological nodal features, including extranodal extension, laterality, and lower neck involvement. Patients with 1 or 2 PLNs had comparable worse OS than those with no PLN (median OS of 1 PLN vs. 2 PLNs vs. 0 PLN: 35.1 vs. 30.5 vs. 40.2 months), but better than those with ≥ 3 PLNs (median OS of 1–2 PLNs vs. 3 PLNs: 32.1 vs. 19.0 months). A proposed nodal category with 0, 1–2 PLNs, and ≥ 3 PLNs exhibited increasingly worse OS (HR of 1–2 PLNs and ≥ 3 PLNs vs. 0 PLN: 2.98 [95% CI: 1.89–4.71], <i>p</i> < 0.001; 5.47 [95% CI: 3.33–9], <i>p</i> < 0.001; respectively) and showed improved prediction power versus current pN staging (C-index: 0.717 vs. 0.713, <i>p</i> < 0.001). PSM analysis revealed that ACRT benefited patients with advanced nodal disease (≥ 3 PLNs) and improved OS. These findings were validated in SEER registry.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The number of PLNs is a better predictor of overall tumor burden for OTSCC and could be a more accurate metric for survival estimation, which should be considered in future simplified pathological nodal staging for better risk stratification and decision-making in subsites of the oral cavity.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"13 24","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70493","citationCount":"0","resultStr":"{\"title\":\"Prognostic Implications of the Number of Lymph Node Metastases in Oral Tongue Squamous Cell Carcinoma: A Population Study of the SEER Database and an Institutional Registry\",\"authors\":\"Wenjie Huang, Yu Zhang, Hao Li, Zhiying Liang, Shumin Zhou, Jie Pan, Hui Xie, Chao Luo, Shuqi Li, Guangying Ruan, Fei Ai, Yanfeng Chen\",\"doi\":\"10.1002/cam4.70493\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>To investigate the impact of the number of positive lymph nodes (PLNs) on long-term survival and pathological nodal stage in patients with oral tongue squamous cell carcinoma (OTSCC).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and Methods</h3>\\n \\n <p>Newly diagnosed and nonmetastatic adult patients with OTSCC who underwent curative resection were identified between January 2010 and December 2020. External validation was performed via the SEER registry. Multivariate Cox proportional hazards model was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of pathological nodal features. Propensity score matching (PSM) was used to assess effect of adjuvant chemoradiotherapy (ACRT).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 518 curative-intent OTSCC patients, the number of PLNs independently predicted overall survival (OS), surpassing other pathological nodal features, including extranodal extension, laterality, and lower neck involvement. Patients with 1 or 2 PLNs had comparable worse OS than those with no PLN (median OS of 1 PLN vs. 2 PLNs vs. 0 PLN: 35.1 vs. 30.5 vs. 40.2 months), but better than those with ≥ 3 PLNs (median OS of 1–2 PLNs vs. 3 PLNs: 32.1 vs. 19.0 months). A proposed nodal category with 0, 1–2 PLNs, and ≥ 3 PLNs exhibited increasingly worse OS (HR of 1–2 PLNs and ≥ 3 PLNs vs. 0 PLN: 2.98 [95% CI: 1.89–4.71], <i>p</i> < 0.001; 5.47 [95% CI: 3.33–9], <i>p</i> < 0.001; respectively) and showed improved prediction power versus current pN staging (C-index: 0.717 vs. 0.713, <i>p</i> < 0.001). PSM analysis revealed that ACRT benefited patients with advanced nodal disease (≥ 3 PLNs) and improved OS. 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引用次数: 0
摘要
背景：探讨口腔舌鳞癌（OTSCC）患者淋巴结阳性数（pln）对其长期生存及病理淋巴结分期的影响。材料和方法：2010年1月至2020年12月期间，新诊断和非转移性成年OTSCC患者接受了根治性切除术。外部验证通过SEER注册中心进行。采用多变量Cox比例风险模型计算病理淋巴结特征的风险比（hr）和95%置信区间（ci）。采用倾向评分匹配（PSM）评价辅助放化疗（ACRT）的效果。结果：在518名有治疗意向的OTSCC患者中，pln的数量独立预测了总生存期（OS），超过了其他病理淋巴结特征，包括结外延伸、侧边和下颈部受损伤。1个或2个PLN患者的OS比无PLN患者差（1个PLN vs 2个PLN vs 0个PLN的中位OS: 35.1个月vs 30.5个月vs 40.2个月），但优于≥3个PLN的患者（1-2个PLN vs 3个PLN的中位OS: 32.1个月vs 19.0个月）。提出节点类别为0,1 - 2 PLN,≥3 PLN表现出越来越糟糕的操作系统(1 - 2 PLN人力资源和≥3 PLN vs . 0 PLN: 2.98(95%置信区间:1.89—-4.71),p结论:PLN的数量是一个更好的整体预测肿瘤负担OTSCC为了生存,可能是一个更准确的指标估计,应该考虑在未来更好的风险分层简化病理淋巴结分期和决策子站的口腔。
Prognostic Implications of the Number of Lymph Node Metastases in Oral Tongue Squamous Cell Carcinoma: A Population Study of the SEER Database and an Institutional Registry
Background
To investigate the impact of the number of positive lymph nodes (PLNs) on long-term survival and pathological nodal stage in patients with oral tongue squamous cell carcinoma (OTSCC).
Materials and Methods
Newly diagnosed and nonmetastatic adult patients with OTSCC who underwent curative resection were identified between January 2010 and December 2020. External validation was performed via the SEER registry. Multivariate Cox proportional hazards model was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of pathological nodal features. Propensity score matching (PSM) was used to assess effect of adjuvant chemoradiotherapy (ACRT).
Results
Among 518 curative-intent OTSCC patients, the number of PLNs independently predicted overall survival (OS), surpassing other pathological nodal features, including extranodal extension, laterality, and lower neck involvement. Patients with 1 or 2 PLNs had comparable worse OS than those with no PLN (median OS of 1 PLN vs. 2 PLNs vs. 0 PLN: 35.1 vs. 30.5 vs. 40.2 months), but better than those with ≥ 3 PLNs (median OS of 1–2 PLNs vs. 3 PLNs: 32.1 vs. 19.0 months). A proposed nodal category with 0, 1–2 PLNs, and ≥ 3 PLNs exhibited increasingly worse OS (HR of 1–2 PLNs and ≥ 3 PLNs vs. 0 PLN: 2.98 [95% CI: 1.89–4.71], p < 0.001; 5.47 [95% CI: 3.33–9], p < 0.001; respectively) and showed improved prediction power versus current pN staging (C-index: 0.717 vs. 0.713, p < 0.001). PSM analysis revealed that ACRT benefited patients with advanced nodal disease (≥ 3 PLNs) and improved OS. These findings were validated in SEER registry.
Conclusion
The number of PLNs is a better predictor of overall tumor burden for OTSCC and could be a more accurate metric for survival estimation, which should be considered in future simplified pathological nodal staging for better risk stratification and decision-making in subsites of the oral cavity.
期刊介绍：
Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas:
Clinical Cancer Research
Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations
Cancer Biology:
Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery.
Cancer Prevention:
Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach.
Bioinformatics:
Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers.
Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.
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