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首页> 外文期刊>Oral oncology >Neck observation is appropriate in T1-2, cN0 oral squamous cell carcinoma without perineural invasion or lymphovascular invasion
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Neck observation is appropriate in T1-2, cN0 oral squamous cell carcinoma without perineural invasion or lymphovascular invasion

机译：颈部观察适用于T1-2，cN0口腔鳞状细胞癌而无神经周浸润或淋巴管浸润的患者

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Objectives Management of cN0 neck, elective neck dissection (END) or observation, remains controversial for T1-2 oral squamous cell carcinoma (OSCC). To allow for the safe observation of cN0 neck, it is mandatory to define predictors with high negative predictive value (NPV) for cervical lymph node (LN) status. Materials and Methods Pathologic re-evaluation was performed in tumors of 253 consecutive patients with T1-2, cN0 OSCC. The predictive roles of pathologic parameters for cervical LN status in guiding neck management were investigated. Results Cervical LN metastasis (LN+) occurred at a similar rate between observation and END groups (20.8% vs. 22.2%, p = 0.807), indicating poor discriminatory value for cervical LN status by clinical judgment. Compared with T classification, tumor thickness and differentiation, PNI/LVI (perineural invasion/lymphovascular invasion) demonstrated the highest NPV (85.5%). Hypothetically using PNI/LVI status to guide neck management, a dramatic reduction in overtreatment rate could be achieved (54.2% to 20.2%), with a minimal increase in undertreatment rate (6.3% to 9.9%). In patients without PNI or LVI (PNI/LVI-), the ultimate neck control rate (96.9% vs. 96.3%, p = 1.000) and 5-year disease-specific survival rate (91.1% vs. 92.8%, p = 0.863) were equivalent between observation and END. However, a significantly higher incidence of neck recurrence was found with observation (16.9% vs. 6.5%, p = 0.031), with 93.8% occurring within one year and 73.3% being successfully salvaged. Conclusion Observation under close follow-up for the first year is appropriate in T1-2, cN0 OSCC without PNI or LVI, for the achievement of equivalent ultimate neck control and 5-year disease-specific survival rates compared with END.
机译：目的对于T1-2型口腔鳞状细胞癌（OSCC），管理cN0颈部，选择性颈部清扫术（END）或观察尚存争议。为了安全地观察cN0颈部，必须为宫颈淋巴结（LN）状态定义具有高阴性预测值（NPV）的预测因子。材料和方法对253例连续的T1-2，cN0 OSCC患者的肿瘤进行病理学重新评估。研究了病理学参数对宫颈LN状态在指导颈部管理中的预测作用。结果观察组和END组之间的宫颈LN转移（LN +）发生率相似（20.8％vs. 22.2％，p = 0.807），表明临床判断对宫颈LN状况的鉴别价值差。与T分类，肿瘤厚度和分化相比，PNI / LVI（神经周浸润/淋巴管浸润）显示出最高NPV（85.5％）。假设使用PNI / LVI状态指导颈部管理，可以显着降低过度治疗率（54.2％至20.2％），而治疗不足率的增加最小（6.3％至9.9％）。在没有PNI或LVI（PNI / LVI-）的患者中，最终颈部控制率（96.9％对96.3％，p = 1.000）和5年疾病特异性存活率（91.1％对92.8％，p = 0.863） ）在观察和END之间相等。然而，观察发现颈部复发率显着更高（16.9％vs. 6.5％，p = 0.031），一年内发生率为93.8％，成功治愈率为73.3％。结论对于不具有PNI或LVI的T1-2，cN0 OSCC，在第一年进行密切随访观察是合适的，以达到与END相当的最终颈部控制和5年疾病特异性生存率。

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