Objective:The T classification of oral squamous cell carcinoma (OSCC) is linear according to the tumor size, excluding T4a by its criteria of invasion into adjacent structures, such as cortical bone. This may lead to the upstaging of otherwise small tumors. The objective was to analyze patients with OSCC and negative nodal staging to assess the impact of T-staging with tumor size on the incidence of occult cervical lymph node metastasis (CLNM) and regional neck failure.Methods:This retrospective cohort study included patients with OSCC and clinically negative necks (cN0), treated surgically between 2010 and 2024. All T4a OSCC classified due to bone invasion were additionally reclassified into T1–T3 based on size and depth of invasion according to the current staging manual. The primary endpoint of this study was the association between OSCC stratified by T-stage and tumor size as well as the presence of occult CLNM.Results:A total of 642 patients were included, with an overall occult CLNM rate of 20.2%. Bone invasion in T1-sized tumors was significantly associated with occult CLNM (OR 6.38, 95% CI: 1.48–27.42), whereas no such association was observed in T2 or T3 tumors (OR 0.80, 95% CI: 0.37–1.73; and OR 0.77, 95% CI: 0.37–1.62, respectively). Additionally, in T1–T2 tumors, bone invasion did not correlate with worse survival outcomes.Conclusions:Bone invasion was not significantly associated with occult CLNM in T2-3 sized OSCC, suggesting that the prognostic relevance is size-dependent. These findings question the uniform upstaging to T4a and support a more differentiated approach, potentially enabling neck management de-escalation in selected early-stage cases.
目的：口腔鳞状细胞癌（OSCC）的T分期依据肿瘤大小线性划分，而T4a分期的判定标准为肿瘤侵犯邻近结构（如皮质骨），这可能导致本属小体积的肿瘤被过度分期。本研究旨在分析淋巴结阴性分期的OSCC患者，评估基于肿瘤大小的T分期对隐匿性颈淋巴结转移（CLNM）发生率及颈部区域治疗失败的影响。 方法：本回顾性队列研究纳入2010年至2024年间接受手术治疗、临床颈部淋巴结阴性（cN0）的OSCC患者。所有因骨侵犯被划分为T4a期的OSCC病例，均依据现行分期手册按肿瘤大小及浸润深度重新划分为T1–T3期。本研究主要终点为按T分期及肿瘤大小分层的OSCC与隐匿性CLNM发生之间的关联。 结果：共纳入642例患者，总体隐匿性CLNM发生率为20.2%。在T1大小肿瘤中，骨侵犯与隐匿性CLNM显著相关（OR 6.38，95% CI：1.48–27.42），而在T2或T3肿瘤中未观察到类似关联（OR分别为0.80，95% CI：0.37–1.73；OR 0.77，95% CI：0.37–1.62）。此外，在T1–T2肿瘤中，骨侵犯与更差的生存结局无显著相关性。 结论：在T2-3大小的OSCC中，骨侵犯与隐匿性CLNM无显著关联，提示其预后相关性具有尺寸依赖性。这些发现对现行统一升级至T4a分期的做法提出质疑，支持采用更具差异化的分期策略，可能为部分早期病例的颈部治疗降阶梯提供依据。
肿瘤(癌症)患者之家