Journal of Prevention and Treatment for Stomatological Diseases ›› 2021, Vol. 29 ›› Issue (11): 776-781.doi: 10.12016/j.issn.2096-1456.2021.11.009

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Research progress on the neck management of oral squamous cell carcinoma with clinically node-positive neck

CHEN Zhen(),ZHANG Wenbo,PENG Xin()   

  1. Department of Oral And Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2020-07-19 Revised:2020-09-27 Online:2021-11-20 Published:2021-07-20
  • Contact: Xin PENG E-mail:18811331518@163.com;pxpengxin@263.net

Abstract:

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial regions. Cervical lymph node metastasis is not only an important biological behavior of oral cancer but also an important factor affecting the prognosis of oral cancer patients. As neck dissection is the most commonly used method of neck management, the appropriate choice of surgical procedure is very important. The current view is that radical neck dissection or modified radical neck dissection can be used for patients with clinically node-positive neck (cN+), while selective neck dissection can be used for patients with clinically node-negative neck (cN0). In recent years, selective neck dissection has been increasingly popularized and applied. Its implications are also gradually expanding from cN0 to cN+. However, there is still no consensus on whether selective neck dissection can also be used in patients with cN+ necks. This article reviews the clinical studies on the neck management of cN+ OSCC patients in recent years, analyzes the effects of different neck dissections on the prognosis of cN+ OSCC patients, and summarizes the treatment principles of neck management.

Key words: selective neck dissection, oral squamous cell carcinoma, cervical lymph node metastasis, postoperative complication, quality of life, prognosis, adjuvant therapy, treatment principles

CLC Number: 

  • R78

Table 1

Comparison of the prognosis of cN+ patients with oral squamous cell carcinoma treated with SND or RND/MRND"

Authors(Year) Country Median follow-up time Clinical N stage Type of neck
dissection
n Overall neck
recurrence
Disease-specific
survival rate
Schiff, et al[18](2005) USA 5.7 years cN1,cN2b-cN2c SND(I-III/IV) 45 5(11.1%) -
RND/MRND 19 1(5.3%) -
Patel, et al[19](2008) Australia 54 months cN1-3 SND(I-III/IV) 24 2(8.3%) -
RND/MRND 43 12(27.9%) -
Yanai, et al[20](2012) Japan 72 months cN1 SND(I) 32 6 (18.8%) 81.3%(3 years)
RND/MRND 36 6 (16.7%) 80%(3 years)
Shin, et al[21](2013) Korea 47 months cN1-cN2a SND(I-III) 20 3(15.0%) 69.2%(2 years)
RND/MRND 34 4(11.8%) 71.8%(2 years)
Battoo, et al[3](2013) India 36 months cN1-cN2 SND(I-III/IV) 37 4(10.8%) 60%(3 years)
RND/MRND - - -
Feng, et al[22](2014) 68 months cN1-cN2b SND(I-III/IV) 89 14(15.7%) T1-2(3 years) T3-4 (3 years)
China 67.6%(Ⅰ-Ⅲ)55.6%(Ⅰ-Ⅳ) 54.8%(Ⅰ-Ⅲ)58.3%(Ⅰ-Ⅳ)
RND/MRND 101 13(12.9%) 61% 51.7%
Shimura, et al[4](2019) Japan 42 months cN1-cN2 SND(I-III) 20 - 71% (cN1)(5 years)
54% (cN2)(5 years)
RND/MRND 21 - -

Figure 1

Strategy of selective neck dissection for cN+ oral squamous cell carcinoma cN+: clinically node-positive neck; ENE: extranodal extension; SND: selective neck dissection; RND: radical neck dissection; MRND: modified radical neck dissection"

[1] 中华医学会耳鼻咽喉头颈外科学分会头颈外科学组. 头颈部鳞状细胞癌颈淋巴结转移处理的专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(1):25-33. doi: 10.3760/cma.j.issn.1673-0860.2016.01.005.
Subspecialty Group of Head and Neck Surgery, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery. Expert consensus on management of cervical lymph node metastasis of head and neck squamous cell carcinoma[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2016, 51(1):25-33. doi: 10.3760/cma.j.issn.1673-0860.2016.01.005.
[2] 中华口腔医学会口腔颌面外科专业委员会肿瘤学组. 口腔颌面部恶性肿瘤颈淋巴结转移的外科诊治指南[J]. 中国口腔颌面外科杂志, 2005, 3(1):3-9. doi: 10.3969/j.issn.1672-3244.2005.01.003.
Chinese Society of Oral and Maxillofacial Surgery. Guideline for evaluation and surgical treatmentof cervical lymph node metastasis from oral and maxillofacial malignances[J]. Chin J Oral Maxillofac Surg, 2005, 3(1):3-9. doi: 10.3969/j.issn.1672-3244.2005.01.003.
[3] Battoo AJ, Hedne N, Ahmad SZ, et al. Selective neck dissection is effective in N1/N2 nodal stage oral cavity squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2013, 71(3):636-643. doi: 10.1016/j.joms.2012.06.181.
doi: 10.1016/j.joms.2012.06.181
[4] Shimura S, Ogi K, Miyazaki A, et al. Selective neck dissection and survival in pathologically node-positive oral squamous cell carcinoma[J]. Cancers, 2019, 11(2):269. doi: 10.3390/cancers11020269.
doi: 10.3390/cancers11020269
[5] Doescher J, Veit JA, Hoffmann TK. The 8th edition of the AJCC Cancer Staging Manual[J]. HNO, 2017, 65(12):956-961. doi: https://doi.org/10.1007/s00106-017-0391-3.
doi: 10.1007/s00106-017-0391-3 pmid: 28717958
[6] 尚伟, 郑家伟. 口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读[J]. 中国口腔颌面外科杂志, 2018, 16(6):533-546. doi: 10.19438/j.cjoms.2018.06.010.
Shang W, Zheng JW. Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx[J]. Chin J Oral Maxillofac Surg, 2018, 16(6):533-546. doi: 10.19438/j.cjoms.2018.06.010.
[7] 尚伟, 郑家伟. 2019年NCCN口腔口咽癌诊疗指南更新解读[J]. 中国口腔颌面外科杂志, 2019, 17(6):481-485. doi: 10.19438/j.cjoms.2019.06.001.
Shang W, Zheng JW. Interpretation of updated NCCN guidelines for diagnosis and treatment of oral and oropharyngeal cancer issued in 2019[J]. Chin J Oral Maxillofac Surg, 2019, 17(6):481-485. doi: 10.19438/j.cjoms.2019.06.001.
[8] Crile G. Landmark article Dec 1, 1906: excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. By George Crile[J]. JAMA, 1987, 258(22):3286-3293. doi: 10.1001/jama.258.22.3286.
doi: 10.1001/jama.1987.03400220086043
[9] Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity[J]. Cancer, 1990, 66(1):109-113. doi: 10.1002/1097-0142(19900701)66:13.0.CO;2-A.
pmid: 2354399
[10] Pantvaidya GH, Pal P, Vaidya AD, et al. Prospective study of 583 neck dissections in oral cancers: implications for clinical practice[J]. Head Neck, 2014, 36(10):1503-1507. doi: 10.1002 /hed.23494.
[11] Patel S, Singh I, Gulati A, et al. A Study on neck nodes in oral cancers, with special reference to skip metastasis[J]. Indian J Otolaryngol Head Neck Surg, 2019, 71(S1):474-481. doi: 10.1007/s12070-018-1360-1.
[12] Woolgar JA. The topography of cervical lymph node metastases revisited: the histological findings in 526 sides of neck dissection from 439 previously untreated patients[J]. Int J Oral Maxillofac Surg, 2007, 36(3):219-225. doi: 10.1016/j.ijom.2006.10.014.
doi: 10.1016/j.ijom.2006.10.014
[13] Davidson BJ, Kulkarny V, Delacure MD, et al. Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract[J]. Am J Surg, 1993, 166(4):395-398. doi: 10.1016/S0002-9610(05)80340-X.
pmid: 8214300
[14] Chepeha DB, Taylor RJ, Chepeha JC, et al. Functional assessment using Constant’s Shoulder Scale after modified radical and selective neck dissection[J]. Head Neck, 2002, 24(5):432-436. doi: 10.1002/hed.10067.
doi: 10.1002/(ISSN)1097-0347
[15] Gane EM, Michaleff ZA, Cottrell MA, et al. Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review[J]. Eur J Surg Oncol, 2017, 43(7):1199-1218. doi: 10.1016/j.ejso.2016.10.026.
doi: S0748-7983(16)30966-0 pmid: 27956321
[16] 李少明, 高岭, 任文豪, 等. 功能性和肩胛舌骨肌上颈淋巴结清扫术治疗cN0/N1期口腔鳞癌的效果比较[J]. 中华医学杂志, 2019, 99(32):2516-2520. doi: 10.3760/cma.j.issn.0376-2491.2019.32.009.
Li SM, Gao L, Ren WH, et al. Functional and supraomohyoid neck dissection in stage cNO/N1 oral squamous cell carcinoma[J]. Zhonghua Yi Xue Za Zhi, 2019, 99(32):2516-2520. doi: 10.3760/cma.j.issn.0376-2491.2019.32.009.
[17] Feng Z, Gao Y, Niu LX, et al. Selective versus comprehensive neck dissection in the treatment of patients with a pathologically node-positive neck with or without microscopic extracapsular spread in oral squamous cell carcinoma[J]. Int J Oral Maxillofac Surg, 2014, 43(10):1182-1188. doi: 10.1016/j.ijom.2014.05.018.
doi: 10.1016/j.ijom.2014.05.018
[18] Schiff BA, Robert DB, El-Nagger A, et al. Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(10):874-878. doi: 10.1001/archotol.131.10.874.
doi: 10.1001/archotol.131.10.874
[19] Patel RS, Clark JR, Gao K, et al. Effectiveness of selective neck dissection in the treatment of the clinically positive neck[J]. Head Neck, 2008, 30(9):1231-1236. doi: 10.1002/hed.20870.
doi: 10.1002/hed.v30:9
[20] Yanai Y, Suglura T, Imajyo I, et al. Retrospective study of selective submandibular neck dissection versus radical neck dissection for N0 or N1 necks in level I patients with oral squamous cell carcinoma[J]. J Oncol, 2012, 2012:1-8. doi: 10.1155/2012/634183.
[21] Shin YS, Koh YW, Kim SH, et al. Selective neck dissection for clinically node-positive oral cavity squamous cell carcinoma[J]. Yonsei Med J, 2013, 54(1):139. doi: 10.3349/ymj.2013.54.1.139.
doi: 10.3349/ymj.2013.54.1.139
[22] Feng Z, Li JN, Niu LX, et al. Supraomohyoid neck dissection in the management of oral squamous cell carcinoma: special consideration for skip metastases at level IV or V[J]. J Oral Maxillofac Surg, 2014, 72(6):1203-1211. doi: 10.1016/j.joms.2013.12.008.
doi: 10.1016/j.joms.2013.12.008
[23] Ferlito A, Rinaldo A, Silver CE, et al. Elective and therapeutic selective neck dissection[J]. Oral Oncol, 2006, 42(1):14-25. doi: 10.1016/j.oraloncology.2005.03.009.
pmid: 15979381
[24] Liaw GA, Yen CY, Chiang WF, et al. Outcome of treatment with total main tumor resection and supraomohyoid neck dissection in oral squamous cell carcinoma[J]. J Formos Med Assoc, 2006, 105(12):971-977. doi: 10.1016/S0929-6646(09)60281-3.
doi: 10.1016/S0929-6646(09)60281-3
[25] Liang L, Zhang T, Kong Q, et al. A meta-analysis on selective versus comprehensive neck dissection in oral squamous cell carcinoma patients with clinically node-positive neck[J]. Oral Oncol, 2015, 51(12):1076-1081. doi: 10.1016/j.oraloncology.2015.10.005.
doi: 10.1016/j.oraloncology.2015.10.005
[26] Kolli VR, Datta RV, Orner JB, et al. The Role of supraomohyoid neck dissection in patients with positive nodes[J]. Arch Otolaryngol Head Neck Surg, 2000, 126(3):413-416. doi: 10.1001/archotol.126.3.413.
doi: 10.1001/archotol.126.3.413
[27] Schmitz S, Machiels JP, Weynand B, et al. Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma[J]. Eur Arch Otorhinolaryngol, 2009, 266(3):437-443. doi: 10.1007/s00405-008-0767-9.
doi: 10.1007/s00405-008-0767-9 pmid: 18648835
[28] Rodrigo JP, Grilli G, Shah JP, et al. Selective neck dissection in surgically treated head and neck squamous cell carcinoma patients with a clinically positive neck: systematic review[J]. Eur J Surg Oncol, 2018, 44(4):395-403. doi: 10.1016/j.ejso.2018.01.003.
doi: S0748-7983(18)30011-8 pmid: 29395434
[29] López F, Fernández-Vañes L, García-Cabo P, et al. Selective neck dissection in the treatment of head and neck squamous cell carcinoma patients with a clinically positive neck[J]. Oral Oncol, 2020, 102:104565. doi: 10.1016/j.oraloncology.2020.104565.
doi: 10.1016/j.oraloncology.2020.104565
[30] Givi B, Linkov G, Ganly I, et al. Selective neck dissection in node-positive squamous cell carcinoma of the head and neck[J]. Otolaryngol Head Neck Surg, 2012, 147(4):707-715. doi: 10.1177/0194599812444852.
doi: 10.1177/0194599812444852
[31] Byers RM, Weber RS, Andrews T, et al. Frequency and therapeutic implications of "skip metastasis" in the neck from squamous carcinoma of the tongue[J]. Head Neck, 1997, 19(1):14-19. doi: 10.1002/(SICI)1097-0347(199701)19: 13.0.CO;2-Y.
doi: 10.1002/(ISSN)1097-0347
[32] Dias FL, Lima RA, Kligerman J, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth[J]. Otolaryngol Head Neck Surg, 2006, 134(3):460-465. doi: 10.1016/j.otohns.2005.09.025.
doi: 10.1016/j.otohns.2005.09.025
[33] Ferlito A, Silver CE, Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies[J]. Br J Oral Maxillofac Surg, 2009, 47(1):5-9. doi: 10.1016/j.bjoms.2008.06.001.
doi: 10.1016/j.bjoms.2008.06.001 pmid: 19121878
[34] 毛驰, 俞光岩. 口腔鳞癌N0和N1颈部淋巴结的处理[J]. 现代口腔医学杂志, 2005(3):316-319. doi: 10.3969/j.issn.1003-7632.2005.03.031.
Mao C, Yu GY. Management of N0 and N1 neck of oral squamous cell carcinoma[J]. J Modern Stomatol, 2005(3):316-319. doi: 10.3969/j.issn.1003-7632.2005.03.031.
[35] Dogan E, Cetinayak HO, Sarioglu S, et al. Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection[J]. J Laryngol Otol, 2014, 128(3):268-273. doi: 10.1017/S002221511 4000267.
doi: 10.1017/S0022215114000267 pmid: 24548727
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