Analyses of clinicopathologic factors affecting neck control after postoperative radiation as adjuvant treatment for lymph node metastasis in head and neck squamous cell carcinoma
10.3760/cma.j.issn.1673-0860.2016.07.002
- VernacularTitle:头颈部鳞状细胞癌术后放疗控制颈部淋巴结转移的临床病理学影响因素分析
- Author:
Bin DI
1
;
Xiaoming LI
;
Jianjun ZHANG
;
Shuang LIU
;
Qi SONG
;
Zhenfeng TAO
;
Cai FAN
Author Information
1. 解放军白求恩国际和平医院耳鼻咽喉头颈外科
- Keywords:
Head and neck neoplasms;
Carcinoma,squamous cell;
Lymphatic metastasis;
Radiotherapy;
Recurrence;
Pathology,clinical
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2016;51(7):485-490
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinicopathologic factors associated with neck control and distant metastasis in patients with neck metastases in head and neck squamous cell carcinoma (HNSCC)after postoperative radiation as adjuvant treatment.Methods Clinicopathologic data of 208 pathologic N + (pN +) patients with HNSCC initially treated with neck dissection and postoperative radiation in Bethune International Peace Hospital of China from January 2004 to December 2009 were reviewed.The clinicopathologic factors,includeding age,sex,primary tumor site,pathologic T and N stage,tumor growth pattern,histological grade,tumor resection margin,size and number of positive lymph node,number of levels with positive lymph node,and extracapsular nodal spread (ECS),were evaluated for their association with neck control and distant metastasis in patients with HNSCC after postoperative radiation.Univariate x2 test and multiple stepwise logistic regression model were used for the analysis.Results Overall 5-year neck control rate after postoperative radiotherapy was 72.6％ (151/208),with 84.0％ (63/75) for SND,72.9％ (78/107) for MRND,and 38.5％ (10/26) for RND,respectively.Univariate analysis showed that neck control after postoperative radiation was related with following factors:primary tumor site,pathologic N stage,size of positive node,number of levels with positive node,number of positive node,and ECS.Pathologic N stage and number of levels with positive lymph node were associated with distant metastasis.Multivariate analysis indicated that ECS was the most significant risk factor for neck metastasis after surgery and postoperative radiotherapy and the number of levels with positive node was the most significant risk factor for distant metastasis.Conclusions ECS is the most important pathologic factor in planning postoperative adjuvant treatment for pN + patients with HNSCC,therefore ECS should be evaluated routinely after neck dissection.The value of postoperative radiotherapy in controlling the ECS-related recurrence after surgery is limited.Postoperative concurrent chemoradiotherapy and targeted therapy can be considered in HNSCC patients with ECS.
