淋巴结产量及淋巴结比率在cN0口腔鳞癌中的预后价值分析

doi:10.19438/j.cjoms.2024.06.008

摘要/Abstract

摘要： 目的： 探讨淋巴结产量(lymph node yield,LNY)和淋巴结比率(lymph node ratio,LNR)在临床淋巴结阴性(cN0)口腔鳞癌(oral squamous cell carcinoma,OSCC)患者中的预后价值。方法： 选择2008年1月—2018年1月于中国科学技术大学附属第一医院接受手术治疗的cN0 OSCC患者151例,分为病理淋巴结阴性(pN0)、病理淋巴结阳性(pN+)2组,分析淋巴结转移的影响因素,以及影响复发和总体生存时间（OS）的因素。其中,颈淋巴清扫术后的LNY是基于文献推荐值16,LNR采用人工受试者(ROC)曲线计算出最佳截断值,分别将患者分为2组。单因素分析采用卡方检验,复发、总体生存时间的多因素分析分别采用二元logistic回归、Cox回归模型进行分析。采用非参数Kaplan-Meier生存曲线比较OS、疾病特异生存时间(DSS)的生存差异。采用SPSS 26.0软件包对数据进行统计学分析。结果： 151例cN0 OSCC患者中,pN0组109例(72.2%),pN+组42例(27.8%)。pN0组的5年OS、DSS显著高于pN+组(P<0.05)。在pN0组,LNY是复发的独立危险因素(P<0.05),浸润深度(depth of invasion,DOI)、LNY是生存的独立危险因素(P<0.05)。OS和DSS生存曲线显示,LNY<16的患者5年生存率(OS为65%、DSS为53%)显著低于LNY≥16的患者(OS为80%、DSS为82%) (P<0.05),可将该部分患者进行危险分层。pN+组中,LNR为复发、总体生存的独立危险因子。对LNR进行生存分析发现,LNR≤0.075的患者,5年生存率(OS为80%、DSS为80%)显著高于LNR>0.075的患者(OS为25%、DSS为33%) (P<0.05)。结论： 在cN0的OSCC患者中,pN0、pN+患者预后存在显著差异,与复发、生存相关。在pN0患者中,复发的患者存在生存差异,LNY是影响复发、生存的独立预后因子。在pN+患者中,LNR是患者复发、生存的独立预后因子,该指标可能更有助于改善这些患者的预后分层能力。

关键词: 口腔鳞癌, 淋巴结产量, 淋巴结比率, 预后, TNM分期

Abstract: PURPOSE: To investigate the prognostic value of lymph node yield(LNY) and lymph node ratio (LNR) in patients with clinically node-negative (cN0) oral squamous cell carcinoma(OSCC). METHODS: A total of 151 patients diagnosed with cN0 OSCC at the First Affiliated Hospital of the University of Science and Technology of China from January 2008 to January 2018 were included. Based on the presence or absence of lymph node metastasis after surgery, the patients were divided into two groups: pathologic node-negative (pN0) and pathologic node-positive (pN+). The factors influencing lymph node metastasis and the factors affecting recurrence and overall survival in pN0 and pN+ group were analyzed. LNY after neck lymphadenectomy was based on the recommended value of 16 in the literature, and the optimal cutoff value for LNR was calculated using receiver operating characteristic(ROC) curve analysis to classify the patients into two groups. Chi-square test was used for univariate analysis, multivariate analysis for recurrence and overall survival was performed using binary logistic regression and Cox regression models, respectively. Nonparametric Kaplan-Meier survival curves were used to compare the differences in overall survival (OS) and disease-specific survival (DSS). SPSS 26.0 software package was used for data analysis. RESULTS: Among 151 cN0 OSCC patients, totally 109 were pN0(72.2%) and 42 were pN+ (27.8%). The 5-year OS and DSS in pN0 group were significantly higher than those in pN+ group (P<0.05). In the multivariate analysis of recurrence and overall survival in the pN0 group, LNY was an independent risk factor for recurrence(P<0.05), and depth of invasion (DOI) and LNY were independent risk factors for survival(P<0.05). OS and DSS survival curves showed that patients with LNY<16 had significantly lower 5-year survival rates(OS: 65%, DSS: 53%) compared to those with LNY≥16(OS: 80%, DSS: 82%)(P<0.05), allowing for risk stratification of this subgroup of patients. In pN+ group, LNR was identified as an independent risk factor for recurrence and overall survival. Survival analysis of LNR showed that the 5-year survival rate of patients with LNR≤0.075(OS: 80%, DSS: 80%) was significantly higher than that of patients with LNR > 0.075(OS: 25%, DSS: 33%)(P<0.05). CONCLUSIONS: In cN0 OSCC, there are differences in prognosis between pN0 and pN+ patients, and these differences are associated with recurrence and survival. In pN0 group, there are survival differences among patients who experience recurrence. LNY is an independent prognostic factor that affects both recurrence and survival, and a LNY value of ≥16 is associated with a better prognosis compared to LNY<16. In pN+ group, patients who experience recurrence also exhibit survival differences. LNR is an independent prognostic factor for recurrence and survival in these patients, and it allows for risk stratification of this subgroup of patients.

Key words: Oral squamous cell carcinoma, Lymph node yield, Lymph node ratio, Prognosis, TNM staging

中图分类号:

R739.8

安星妃, 章礼玉, 彭晖, 王倩, 翁海燕, 周瑜. 淋巴结产量及淋巴结比率在cN0口腔鳞癌中的预后价值分析[J]. 中国口腔颌面外科杂志, 2024, 22(6): 563-571.

AN Xing-fei, ZHANG Li-yu, PENG Hui, WANG Qian, WENG Hai-yan, ZHOU Yu. Analysis of the prognostic value of lymph node yield and lymph node ratio in cN0 oral squamous cell carcinoma[J]. China J Oral Maxillofac Surg, 2024, 22(6): 563-571.

参考文献

[1] Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] El-Naaj IA, Leiser Y, Shveis M, et al.Incidence of oral cancer occult metastasis and survival of T1-T2N0 oral cancer patients[J]. J Oral Maxillofac Surg, 2011, 69(10): 2674-2679.
[3] Choi KY, Park SC, Kim JH, et al.The occult nodal metastasis rate of early tongue cancer (T1-T2): a protocol for a systematic review and meta-analysis[J]. Medicine (Baltimore), 2021,100(3): e24327.
[4] Al-Moraissi EA, Alkhutari AS, de Bree R, et al. Management of clinically node-negative early-stage oral cancer: network meta-analysis of randomized clinical trials[J]. Int J Oral Maxillofac Surg, 2024, 53(3): 179-190.
[5] Govers TM, Takes RP, Baris KM, et al.Management of the N0 neck in early stage oral squamous cell cancer: a modeling study of the cost-effectiveness[J]. Oral Oncol, 2013, 49(8): 771-777.
[6] Anderson EM, Luu M, Chung EM, et al.Re-examining predictors of pathologic lymph node positivity in clinically node negative oral cavity cancer[J]. Oral Oncol, 2023, 144: 106490.
[7] Beltramini GA, Belloni LM, Fusco N, et al.Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma[J]. Head Neck, 2021,43(10): 2876-2882.
[8] Altuwaijri AA, Alessa MA, Abuhaimed AA, et al.Lymph node yield as a prognostic factor in clinically node negative oral cavity squamous cell carcinoma[J]. Saudi Med J, 2021, 42(12): 1357-1361.
[9] Sundaram GA, Chokkattu JJ, Krishnan M, et al.Lymph Node ratio as a prognostic factor for oral tongue squamous cell carcinoma: a retrospective study[J]. Cureus, 2023,15(8): e44109.
[10] Zanoni DK, Patel SG.New AJCC: how does it impact oral cancers?[J]. Oral Oncol, 2020, 104: 104607.
[11] Goel V, Parihar PS, Parihar A, et al. Accuracy of MRI in prediction of tumour thickness and nodal stage in oral tongue and gingivobuccal cancer with clinical correlation and staging[J]. J Clin Diagn Res, 2016,10(6): TC01-TC05.
[12] 周瑜,段贤捷,翁海燕,等. 浸润深度在口腔鳞状细胞癌预后中的价值[J]. 实用肿瘤杂志, 2023,38(2):173-179.
Zhou Y, Duan XJ, Weng HY, et al.The value of infiltration depth in the prognosis of oral squamous cell carcinoma[J]. Journal of Practical Oncology, 2023,38(2):173-179.
[13] Subramaniam N, Balasubramanian D, Murthy S, et al.Predictors of locoregional control in stage I/II oral squamous cell carcinoma classified by AJCC 8th edition[J]. Eur J Surg Oncol, 2019, 45(11): 2126-2130.
[14] Colonia-García A, Salazar-Peláez LM, Serna-Ortiz CA, et al.Prognostic value of lymphovascular and perineural invasion in squamous cell carcinoma of the tongue[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2022,133(2):207-215.
[15] Kuo P, Mehra S, Sosa JA, et al.Proposing prognostic thresholds for lymph node yield in clinically lymph node-negative and lymph node-positive cancers of the oral cavity[J]. Cancer, 2016,122(23): 3624-3631.
[16] Nguyen E, Mckenzie J, Clarke R, et al.The indications for elective neck dissection in T1N0M0 oral cavity squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2021,79(8):1779-1793.
[17] D'Cruz AK, Dhar H, Vaish R, et al. Depth of invasion in early oral cancers- is it an independent prognostic factor?[J]. Eur J Surg Oncol, 2021,47(8):1940-1946.
[18] Kumar A, Ghai S, Mhaske S, et al.Elective neck dissection versus therapeutic neck dissection in clinically node-negative early stage oral cancer: a meta-analysis of randomized controlled trials[J]. J Maxillofac Oral Surg, 2022, 21(2): 340-349.
[19] 周瑜,翁海燕,司呈云,等. 第8版TNM分期修订版对早期口腔黏膜鳞癌患者预后及危险分层作用的临床研究[J]. 中国口腔颌面外科杂志, 2022,20(6):571-576.