淋巴结外扩展对口腔鳞癌患者TNM分期及生存预后的影响  

Effect of extranodal extension on TNM staging and survival in patients with oral squamous cell carcinoma

作　　者：李贵忠 李洁莹 周凯 孟宇翔 王可心 葛胜优 宋凯[1,2] 冯元勇[1,2] 陶月琴 展晓红[3] 尚伟[1,2] LI Gui-zhong;LI Jie-ying;ZHOU Kai;MENG Yu-xiang;WANG Ke-xin;GE Sheng-you;SONG Kai;FENG Yuan-yong;TAO Yue-qin;ZHAN Xiao-hong;SHANG Wei(Department of Oral and Maxillofacial Surgery,Affiliated Hospital of Qingdao University,Qingdao 266003;School of Stomatology,Qingdao University,Qingdao 266003;Department of Pathology,Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong Province,China)

机构地区：[1]青岛大学附属医院口腔颌面外科,山东青岛266003 [2]青岛大学口腔医学院,山东青岛266003 [3]青岛大学附属医院病理科,山东青岛266003

出　　处：《中国口腔颌面外科杂志》2023年第4期377-383,共7页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:通过分析淋巴结外扩展(extranodal extension,ENE)指标纳入到肿瘤分期后对口腔鳞癌患者TNM分期变化及生存的影响,了解ENE对口腔鳞癌治疗决策及预后评估的意义。方法:回顾分析2014年1月—2017年6月青岛大学附属医院接受手术治疗的485例原发口腔鳞癌(OSCC)患者,对所有患者按AJCC第7版与AJCC第8版TNM分期标准分别进行N分期、TNM分期,采用SPSS 26.0软件包处理数据,以Kaplan-Meier法绘制患者总体生存率(overall survival,OS)和疾病别生存率(disease-specific survival,DSS)的生存曲线,并进行Log-rank检验,使用C指数和AIC评价预测性能。结果:485例OSCC患者中,69例ENE阳性患者(14.43%)发生pN分期改变(pN2a期16例、pN3b期53例),67例ENE阳性患者(13.81%)发生pTNM改变(ⅣA期14例,ⅣB期53例)。N分期、TNM分期与ENE相关的患者,OS和DSS生存模型分析显示,ENE阳性患者生存率(OS:27.1%,DSS:31.2%)显著低于ENE阴性患者(OS:72.2%,DSS:78.0%),AJCC第8版分期系统的AIC明显低于第7版,两者的C指数差异不大。结论:ENE指标纳入后,使患者TNM分期发生很大变化,晚期患者明显增多,生存预后变得更差。ENE指标能够更客观反映患者状况,对口腔癌治疗决策及预后评估有重要意义。PURPOSE:By analyzing the influence of extranodal extension(ENE)on TNM staging manual and survival after included into the staging,to learn about the significance of ENE on clinical decision-making and prognosis of oral cancer.METHODS:A retrospective cohort study of 485 patients with primary oral squamous cell carcinoma(OSCC)from January 2014 to June 2017 was performed in the Affiliated Hospital of Qingdao University.The AJCC 7th and 8th edition staging systems was applied to the patients.Overall survival and disease-specific survival were analyzed by Kaplan-Meier analysis and Log-rank test with SPSS 26.0 software package.Concordance index and Akaike information criterion(AIC)was used to evaluate the system’s prognostic capacity.RESULTS:A total of 485 patients with OSCC were followed up.The pathological N stage of 69(14.43%)patients(including 16 pN2a and 53 pN3b)was changed by extranodal extension.The pathological TNM stage of 67(13.81%)patients(including 14ⅣA and 53ⅣB)was also changed because of ENE.Overall survival and disease-specific survival model analysis of N stage,TNM stage and ENE showed that patients with positive ENE(OS:27.1%,DSS:31.2%)had a lower survival rate than those with negative ENE(OS:72.2%,DSS:78.0%).AIC of AJCC 8th edition staging systems was lower than 7th edition and there was little difference between them in terms of concordance index.CONCLUSIONS:Extranodal extension changed TNM staging of OSCC patients.The number of advanced patients increased significantly and the survival prognosis became worse.ENE can objectively refect the status of the patients.It has more guiding significance for decision-making and prognosis evaluation of oral cancer patients.

关 键 词：淋巴结外扩展 口腔癌 口腔鳞状细胞癌 AJCC第8版 TNM分期 生存率 

分 类 号：R739.8[医药卫生—肿瘤]