cT1N0M0口腔鳞状细胞癌浸润深度对预测淋巴结转移和评价预后的影响

Effect of depth of invasion of cT1N0M0 OSCC on predicting lymph node metastasis and assessing prognosis

目的:探讨早期口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)浸润深度(depth of invasion,DOI)对预测淋巴结转移与评价预后的影响。方法:收集2015年1月至2017年12月确诊为早期OSCC患者的数据,分别评估病理DOI和淋巴结转移2个指标。通过受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积(area under curve,AUC)预测OSCC发生淋巴结转移的DOI界值,同时比较不同DOI分组的淋巴结转移率及生存曲线差异。结果:本研究共纳入94例早期OSCC患者,中位随访年龄约66岁,中位随访时间约为35.5个月,其中18例患者出现淋巴结转移,平均DOI为6.09 mm,而其余受试者平均DOI为3.61 mm(P<0.05)。ROC曲线的AUC为0.86,最佳DOI界值为4.41 mm(敏感度78%,特异度84%)。当DOI>4.41 mm时,OSCC患者发生淋巴结转移率较高(14.89%vs4.25%,P<0.05),中位生存期降低(41.4个月vs52.6个月;HR=1.80,95%CI=0.88~3.69,P=0.10)。结论:DOI较大时,早期OSCC淋巴结转移发生率较高,但患者生存预后未见明显下降,提示该指标尚不能成为预测淋巴结转移及预后的独立影响因素。

Objective:To study the effect of the depth of invasion(DOI)on predicting lymph node metastasis and evaluating prognosis in patients with early oral squamous cell carcinoma(OSCC).Methods:Patients with early OSCC from January 2015 to December 2017 were enrolled and evaluated for pathological DOI and lymph node metastasis.The DOI cutoff value of lymph node metastasis in OSCC was predicted by the area under curve(AUC)of the receiver operating characteristic(ROC)curve.Moreover,the difference of lymph node metastasis rate and survival curve among different DOI groups was compared.Results:Ninety four early OSCC patients were included,with the median follow-up age of 66 and median follow-up time of 35.5 months.Pathological metastasis-positive node were observed in 18 patients with the average DOI of 6.09 mm;the average DOI of others was 3.61 mm(P<0.05).The area under the ROC curve was 0.86,and the optimal DOI cutoff value was 4.41 mm(sensitivity 78%;specificity 84%).When DOI>4.41 mm,lymph node metastasis rate was higher,that is 14.89%vs 4.25%(P<0.05)and the median survival was shorter(41.4 months vs 52.6 months;HR:1.80,95%CI:0.88~3.69,P=0.10).Conclusion:DOI in early OSCC showed positive correlation with the lymph node metastasis rate.However,the prognosis of these patients was not apparently worse,indicating the index may not be an independent predictor for both lymph node metastasis and prognosis in early OSCC patients.