T1-T2期口腔鳞癌根治术后颈淋巴结转移的影响因素分析及预测模型构建

doi:10.19438/j.cjoms.2025.05.007

摘要/Abstract

摘要： 目的: 探讨T1-T2期口腔鳞状细胞癌（口腔鳞癌,oral squamous cell carcinoma,OSCC）根治术后淋巴结转移的相关危险因素,并构建列线图风险预测模型。方法: 收集徐州市中心医院134例T1-T2期OSCC患者的临床资料,包括一般情况、颈淋巴结转移情况、组织分化程度、肿瘤出芽、浸润深度、淋巴管血管侵犯、周围神经侵犯、鳞状细胞癌抗原（SCC-Ag）等相关指标。通过logistic回归分析筛选出颈淋巴结转移的独立影响因素,进一步构建列线图,使预测模型可视化。绘制受试者工作特征曲线、校准曲线和临床决策曲线,依次对预测模型的区分度、校准度及临床有效性进行评价。结果: T分期、组织分化程度、浸润深度、淋巴管血管侵犯是早期OSCC发生颈淋巴结转移的独立影响因素。列线图预测模型的曲线下面积（AUC）为0.875,灵敏度为87.80%,特异度为72.04%,表明该模型具有良好的区分度和校准度。临床决策曲线显示,该列线图预测早期OSCC颈淋巴结转移风险的净获益较大,具有良好的临床有效性。结论: T分期、组织分化程度、浸润深度及淋巴管血管侵犯是影响T1-T2期OSCC颈淋巴结转移的独立危险因素,据此建立的列线图预测模型具有良好的检测效能,可为早期OSCC患者制订精准临床治疗方案提供参考。

关键词: 口腔鳞癌, 头颈癌, 颈淋巴结转移, 浸润深度, 淋巴管血管侵犯, 列线图, 预测模型

Abstract: PURPOSE: To investigate the influencing factors for cervical lymph node metastasis in stage T1 and T2 oral squamous cell carcinoma(OSCC) after radical surgery and to construct nomogram prediction models. METHODS: This retrospective cohort study collected clinical data from 134 patients diagnosed with stage T1-T2 OSCC at Xuzhou Central Hospital. The data included patients' general information, cervical lymph node metastasis, tissue differentiation degree, tumor budding, depth of invasion, lymphovascular invasion, peripheral nerve invasion, squamous cell carcinoma antigen (SCC-Ag) levels, et al. Logistic regression analysis was employed to identify independent factors influencing cervical lymph node metastasis, leading to the construction of a nomogram to visualize the prediction model. The study also involved drawing receiver operating characteristic curves, calibration curves, and clinical decision curves to evaluate the discrimination, calibration, and clinical validity of the prediction model. RESULTS: T stage, degree of tissue differentiation, depth of invasion and lymphovascular invasion were independent factors influencing cervical lymph node metastasis in early OSCC. The area under the curve(AUC) for the nomogram prediction model was 0.875, with a sensitivity of 87.80% and a specificity of 72.04%, demonstrating good discrimination and calibration. The clinical decision curve analysis revealed that this nomogram offered a significant net benefit in predicting the risk of cervical lymph node metastasis in early-stage OSCC, affirming its clinical validity. CONCLUSIONS: T stage, degree of tissue differentiation, depth of invasion, and lymphovascular invasion were independent risk factors for cervical lymph node metastasis in patients with T1-T2 stage oral squamous cell carcinoma. The established nomogram prediction model demonstrated strong detection performance and could be effectively utilized for patients with clinically early-stage OSCC. These precise treatment plans offered valuable reference points.

Key words: Oral squamous cell carcinoma, Head and neck cancer, Cervical lymph node metastasis, Depth of infiltration, Lymphatic vascular invasion, Nomogram, Predictive model

中图分类号:

R739.8

章旺茹, 陈媛媛, 李志萍, 孟箭, 彭森. T1-T2期口腔鳞癌根治术后颈淋巴结转移的影响因素分析及预测模型构建[J]. 中国口腔颌面外科杂志, 2025, 23(5): 469-475.

Zhang Wangru, Chen Yuanyuan, Li Zhiping, Meng Jian, Peng Sen. Influencing factors of cervical lymph node metastasis after radical surgery for oral squamous cell carcinoma in stages T1 and T2 and construction of a prediction model[J]. China J Oral Maxillofac Surg, 2025, 23(5): 469-475.

参考文献

[1] Johnson DE, Burtness B, Leemans CR, et al.Head and neck squamous cell carcinoma[J]. Nat Rev Dis Primers, 2020, 6(1): 92-140.
[2] Jung K, Narwal M, Min SY, et al.Squamous cell carcinoma of head and neck: what internists should know[J]. Korean J Intern Med, 2020, 35(5): 1031-1044.
[3] Bittar RF, Ferraro HP, Ribas MH, et al.Predictive factors of occult neck metastasis in patients with oral squamous cell carcinoma[J]. Braz J Otorhinolaryngol, 2016, 82(5): 543-547.
[4] Jiménez-labaig P, Rullan A, Braña I, et al. Intratumoral therapies in head and neck squamous cell carcinoma: a systematic review and future perspectives[J]. Cancer Treat Rev, 2024,127: 102746.
[5] Szturz P, Vermorken JB.Management of recurrent and metastatic oral cavity cancer: raising the bar a step higher[J]. Oral Oncol, 2020, 101: 104492.
[6] Jangir NK, Singh A, Jain P, et al.The predictive value of depth of invasion and tumor size on risk of neck node metastasis in squamous cell carcinoma of the oral cavity: a prospective study[J]. J Cancer Res Ther, 2022, 18(4): 977-983.
[7] Kato K, Miyazawa H, Kobayashi H, et al.The pattern and spread of invasion can predict late cervical lymph node metastasis in early tongue squamous cell carcinoma[J]. Diagn Pathol, 2023, 18(1): 87-92.
[8] Shi S, Meng Y, Jiao J, et al.A nomogram-based predictive model for tooth survival in Chinese patients with periodontitis: an 11-year retrospective cohort study[J]. J Clin Periodontol, 2024, 51(10): 1384-1394.
[9] Silva FFVE, Caponio VCA, Pérez-Sayáns M, et al.Tumor budding is a prognostic factor in head and neck squamous cell carcinoma: a comprehensive meta-analysis and trial sequential analysis[J]. Crit Rev Oncol Hematol, 2024, 193: 104202.
[10] Lugli A,Kirsch R,Ajioka Y,et al.Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016[J]. Mod Pathol, 2017, 30(9): 1299-1311.
[11] Yokota Y, Hasegawa T, Yamakawa N, et al.Comparison of the 8th edition of TNM staging of oral cancer with the 7th edition and its prognostic significance using clinical depth of invasion and extranodal extension[J]. Oral Oncol, 2023, 145: 106519.
[12] Tam S, Amit M, Zafereo M, et al.Depth of invasion as a predictor of nodal disease and survival in patients with oral tongue squamous cell carcinoma[J]. Head Neck, 2019, 41(1): 177-184.
[13] Kus KJB, Murad F, Smile TD, et al.Higher metastasis and death rates in cutaneous squamous cell carcinomas with lymphovascular invasion[J]. J Am Acad Dermatol, 2022, 86(4): 766-773.
[14] Schmitd LB, Scanlon CS, D’silva NJ.Perineural invasion in head and neck cancer[J]. J Dent Res, 2018, 97(7): 742-750.
[15] Chen P, Jiao L, Ren F, et al.Clinical value of serum squamous cell carcinoma antigen levels in predicting chemosensitivity, lymph node metastasis, and prognosis in patients with cervical squamous cell carcinoma[J]. BMC cancer, 2020, 20(1): 423.
[16] Takamizawa S, Shimoi T, Yoshida M, et al.Diagnostic value of tumor markers in identifying favorable or unfavorable subsets in patients with cancer of unknown primary: a retrospective study[J]. BMC cancer, 2022, 22(1): 412.
[17] Chamoli A, Gosavi AS, Shirwadkar UP, et al.Overview of oral cavity squamous cell carcinoma: risk factors, mechanisms, and diagnostics[J]. Oral Oncol, 2021, 121: 105451.
[18] Bugshan A, Farooq I.Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis[J]. F1000Res, 2020, 9: 229.
[19] D'alessandro AF, Pinto FR, Lin CS, et al. Oral cavity squamous cell carcinoma: factors related to occult lymph node metastasis[J]. Braz J Otorhinolaryngol, 2015, 81(3): 248-254.
[20] Doll C, Mrosk F, Wuester J, et al.Pattern of cervical lymph node metastases in squamous cell carcinoma of the upper oral cavity-how to manage the neck[J]. Oral Oncol, 2022, 130: 105898.
[21] Dieterich LC, Tacconi C, Ducoli L, et al.Lymphatic vessels in cancer[J]. Physiol Rev, 2022, 102(4): 1837-1879.
[22] Chang CW, Wang C, Lu CJ, et al.Incidence and prognostic significance of extranodal extension in isolated nodal recurrence of oral squamous cell carcinoma[J]. Radiother Oncol, 2022, 167: 81-88.
[23] De Paz D, Kao HK, Huang Y, et al.Prognostic stratification of patients with advanced oral cavity squamous cell carcinoma[J]. Curr Oncol Rep, 2017, 19(10): 65.
[24] Probert JC, Thompson RW, Bagshaw MA.Patterns of spread of distant metastases in head and neck cancer[J]. Cancer, 1974, 33(1): 127-133.
[25] Zhang X, Li B.Updates of liquid biopsy in oral cancer and multiomics analysis[J]. Oral Dis, 2023, 29(1): 51-61.
[26] Alsharif U, Steller D, Falougy M, et al.The benefit of postoperative radiotherapy and extending neck dissection in pT1-2 oral squamous cell carcinoma with a single ipsilateral cervical lymph node metastasis (pN1)[J]. Anticancer Res, 2022, 42(1): 97-104.
[27] Koyfman SA, Ismaila N, Crook D, et al.Management of the neck in squamous cell carcinoma of the oral cavity and oropharynx: ASCO clinical practice guideline[J]. J Clin Oncol, 2019, 37(20): 1753-1774.
[28] Ding Z, Li Y, Pan X, et al.Sentinel lymph node biopsy versus elective neck dissection in squamous cell carcinoma of the oral cavity with a clinically N0 neck: systematic review and meta‐analysis of prospective studies[J]. Head Neck, 2021, 43(10): 3185-3198.
[29] Kato K, Miyazawa H, Kobayashi H, et al.The pattern and spread of invasion can predict late cervical lymph node metastasis in early tongue squamous cell carcinoma[J]. Diagn Pathol, 2023, 18(1): 87-92.
[30] Ventre KS, Karakousi T, Lund AW.Lymph node metastasis fuels systemic disease[J]. Trends Cancer, 2022, 8(8): 623-625.
[31] Tomioka H, Yamagata Y, Oikawa Y, et al.Risk factors for distant metastasis in locoregionally controlled oral squamous cell carcinoma: a retrospective study[J]. Sci Rep, 2021, 11(1): 5213-5219.
[32] Yokota Y, Hasegawa T, Yamakawa N, et al.Comparison of the 8th edition of TNM staging of oral cancer with the 7th edition and its prognostic significance using clinical depth of invasion and extranodal extension[J]. Oral Oncol, 2023, 145: 106519.
[33] Ruffin AT, Cillo AR, Tabib T, et al.B cell signatures and tertiary lymphoid structures contribute to outcome in head and neck squamous cell carcinoma[J]. Nat Commun, 2021, 12(1): 3349.
[34] Spoerl S, Gerken M, Fischer R, et al.Lymphatic and vascular invasion in oral squamous cell carcinoma: implications for recurrence and survival in a population-based cohort study[J]. Oral Oncol, 2020, 111: 105009.