Background/Objectives:Lymph node metastases represent the most important prognostic factor for survival in patients with localized squamous cell carcinoma (SCC) of the oral cavity. In patients with carcinoma of the tongue or floor of the mouth, elective neck dissection (END) has been the standard of care, but it has been replaced at many centers by sentinel lymph node biopsy (SLNB). This study’s purpose was to measure and compare recurrence rates between END and SLNB in patients with early SCC of the oral cavity.Methods:Patients were included in this retrospective monocenter cohort study, performed at the University Hospital of Zürich, if they underwent either END or SLNB for oral squamous cell carcinoma (OSCC) of the tongue or floor of the mouth between January 2008 and December 2018. Only patients with early-stage tumors and a clinically negative neck (T1 or T2; cN0) who had a follow-up period of at least 5 years were included. Patients with a T3 or T4 tumor or a clinically positive neck were excluded, as were those who previously underwent therapy for another head and neck carcinoma. The predictor variable was the surgical treatment used, with subjects divided into two groups: END and SLNB. The main outcome variable was the time to recurrent disease, defined as the time between the primary surgical treatment and the diagnosis of recurrence. The covariates were primary tumor location, pT status, pN status, histopathological grade and postoperative radiotherapy. We used descriptive analysis, univariate analysis and the logrank test, with ap-value < 0.05 considered statistically significant. We deliberately refrained from multivariate analysis due to insignificant statistical results in the univariate analysis.Results:In total, 82 patients (46 male, 36 female; median age at the time of surgery: 58.9 years) were included, with a median observation period of 4.3 years. The main primary tumor location was the floor of the mouth (62.2%). The SLNB cohort had smaller primary tumors in comparison to the END cohort (20% vs. 37% pT2, respectively). Furthermore, pN+ disease was more prevalent in the END group in comparison to the SLNB group (81.8% vs. 74.1% pN0, respectively). Recurrence-free survival was not significantly different between the two groups. Subgroup analysis demonstrated a higher risk of recurrent disease in pN+ groups undergoing SLNB compared to those undergoing END.Conclusions:We demonstrate that SLNB is a useful tool for assessing lymph nodes of the neck. In cases of pN+ necks after SLNB and subsequent neck dissection, patients need to be closely followed up with due to the risk of recurrent disease.
背景/目的：淋巴结转移是影响局限性口腔鳞状细胞癌（SCC）患者生存最重要的预后因素。对于舌或口底癌患者，择区性颈清扫术（END）曾是标准治疗方案，但在许多中心已被前哨淋巴结活检（SLNB）取代。本研究旨在测量并比较早期口腔鳞癌患者接受END与SLNB后的复发率。 方法：这项回顾性单中心队列研究在苏黎世大学医院开展，纳入2008年1月至2018年12月期间因舌或口底口腔鳞状细胞癌（OSCC）接受END或SLNB的患者。仅纳入早期肿瘤且颈部临床阴性（T1或T2；cN0）、随访期至少5年的患者。排除T3或T4肿瘤、颈部临床阳性或既往接受过其他头颈癌治疗的患者。预测变量为手术治疗方式，受试者分为END组和SLNB组。主要结局变量为疾病复发时间，定义为初次手术治疗至确诊复发的时间间隔。协变量包括原发肿瘤部位、pT分期、pN分期、组织病理学分级及术后放疗。采用描述性分析、单变量分析和对数秩检验，以p值<0.05为具有统计学显著性。由于单变量分析未显示显著统计学结果，本研究未进行多变量分析。 结果：共纳入82例患者（男性46例，女性36例；手术时中位年龄58.9岁），中位观察期为4.3年。主要原发肿瘤部位为口底（62.2%）。与END组相比，SLNB组的原发肿瘤更小（pT2分期占比分别为20% vs. 37%）。此外，END组的pN+疾病比例高于SLNB组（pN0占比分别为81.8% vs. 74.1%）。两组间的无复发生存率无显著差异。亚组分析显示，在pN+患者中，接受SLNB者比接受END者具有更高的疾病复发风险。 结论：本研究证实SLNB是评估颈部淋巴结的有效工具。对于SLNB后经颈清扫术确诊为pN+的患者，因存在疾病复发风险，需进行密切随访。
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