Background: The extra-capsular spread (ECS) of lymph node metastasis (LNM) is a hallmark of aggressive primary tumor phenotype in head and neck cancer (HNC); however, the factors influencing ECS are poorly understood. Patients and Methods: This was a retrospective study, including 190 cases of oral tongue cancer (OTC), 148 cases of oropharyngeal cancer (OPC) (118 HPV-positive and 30 HPV-negative), and 100 cases of hypopharyngeal cancer (HPC). Tumor dimension, tumor biological variables (lymphovascular/perineural invasion and histologic grade), and LNM variables (LNM number and size) were analyzed according to the presence of ECS using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. Results: LNM variables were significant factors for ECS in all subsites of HNC (p< 0.05), except HPV-positive OPC. In OTC, tumor dimensional variables were significantly related to ECS (p< 0.01). Meanwhile, in OPC and HPC, neither the primary tumor dimension nor the T status were significant factors for ECS occurrence. The predictability of ECS by ROC curve using multiple variables was 0.819 [95% confidence interval: 0.759–0.878] in OTC, 0.687 [0.559–0.815] in HPV-positive OPC, 0.823 [0.642–1.000] in HPV-negative OPC, and 0.907 [0.841–0.973] in HPC. Conclusion: LNM variables were correlated with ECS occurrence for most HNC subsites, and site-dependent primary tumor characteristics might contribute differentially to the ECS development of LNM in HNC.
背景：淋巴结转移的包膜外扩散是头颈部癌症中侵袭性原发肿瘤表型的标志，但其影响因素尚不明确。患者与方法：本研究为回顾性分析，纳入190例舌癌、148例口咽癌（其中118例HPV阳性、30例HPV阴性）及100例下咽癌病例。通过多变量逻辑回归与受试者工作特征曲线分析，根据包膜外扩散存在情况，对肿瘤尺寸、肿瘤生物学变量（淋巴血管/神经侵犯及组织学分级）及淋巴结转移变量（转移数量与大小）进行统计分析。结果：除HPV阳性口咽癌外，淋巴结转移变量在所有头颈癌亚部位中均为包膜外扩散的显著影响因素（p<0.05）。在舌癌中，肿瘤尺寸变量与包膜外扩散显著相关（p<0.01）；而在口咽癌与下咽癌中，原发肿瘤尺寸及T分期均非包膜外扩散发生的显著影响因素。通过多变量构建的受试者工作特征曲线对包膜外扩散的预测效能分别为：舌癌0.819[95%置信区间：0.759–0.878]，HPV阳性口咽癌0.687[0.559–0.815]，HPV阴性口咽癌0.823[0.642–1.000]，下咽癌0.907[0.841–0.973]。结论：淋巴结转移变量与多数头颈癌亚部位的包膜外扩散发生相关，而原发肿瘤特征对淋巴结转移包膜外扩散发展的影响存在部位特异性差异。
肿瘤(癌症)患者之家