The prognosis of neck dissection with sternocleidomastoid muscle preservation and resection in advanced oral squamous cell carcinoma: a retrospective cohort analysis

doi:10.19439/j.sjos.2023.06.009

Abstract

Abstract: PURPOSE: To investigate the prognosis of advanced oral squamous cell carcinoma (AOSCC) patients undergoing neck dissection with sternocleidomastoid muscle (SCM) preservation and resection. METHODS: From January 2013 to June 2017, a total of 235 AOSCC patients(stage Ⅲ and stage Ⅳ) who were diagnosed and underwent neck dissection at the Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Guangxi Medical University, were collected and followed-up. The differences in overall survival（OS）, local recurrence-free survival (LRFS) and regional recurrence-free survival (RRFS) were compared between different surgical procedures. SPSS 25.0 software package was used for statistical analysis. RESULTS: Among 235 patients with postoperative follow-up, 101 patients retained the SCM during operation, and 134 patients had SCM removed. There was no significant difference in 5-year survival rate and 5-year regional recurrence rate between the SCM preservation group and the SCM resection group. Kaplan-Meier method of univariate analysis showed that SCM preservation or resection had no significant difference in OS, LRFS and RRFS. Cox multivariate regression analysis results showed that there was no significant difference between different surgical procedures in OS, LRFS and RRFS, while N stage and postoperative chemoradiotherapy were independent influencing factors for OS, LRFS and RRFS in AOSCC patients. CONCLUSIONS: Neck dissection with SCM preservation in AOSCC patients has no effect on survival and recurrence (including local recurrence and regional recurrence). It is feasible for AOSCC patients to undergo SCM-preserving neck dissection when metastatic cervical lymph nodes do not invade SCM. N stage and postoperative chemoradiotherapy affect the prognosis of AOSCC patients.

Key words: Advanced Oral squamous cell carcinoma, Neck dissection, Sternocleidomastoid muscle excision, Prognosis

CLC Number:

R739.8

CHEN Xing-jin, FAN Ran-yi, TAO Shi-cheng, XUE Rui, WEN Xu-tao, MAI Hua-ming. The prognosis of neck dissection with sternocleidomastoid muscle preservation and resection in advanced oral squamous cell carcinoma: a retrospective cohort analysis[J]. Shanghai Journal of Stomatology, 2023, 32(6): 609-614.

References

[1] Wong T, Wiesenfeld D.Oral cancer[J]. Aust Dent J, 2018, 63(Suppl 1): S91-S99.
[2] 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.
[3] Caudell JJ, Gillison ML, Maghami E, et al.NCCN Guidelines^® insights: head and neck cancers, version 1.2022[J]. J Natl Compr Canc Netw, 2022, 20(3): 224-234.
[4] Pan R, Zhu M, Yu C, et al.Cancer incidence and mortality: a cohort study in China, 2008-2013[J]. Int J Cancer, 2017, 141(7): 1315-1323.
[5] Holmes JD.Neck dissection: nomenclature, classification, and technique[J]. Oral Maxillofac Surg Clin North Am, 2008, 20(3): 459-475.
[6] Weckx A, Riekert M, Grandoch A, et al.Time to recurrence and patient survival in recurrent oral squamous cell carcinoma[J]. Oral Oncol, 2019, 94: 8-13.
[7] Medina JE.A rational classification of neck dissections[J]. Otolaryngol Head Neck Surg, 1989, 100(3): 169-176.
[8] Jaehne M, Ussmüller J, Kehrl W.Resection of the sternocleidomastoid muscle during radical neck dissection[J]. Eur Arch Otorhinolaryngol, 2001, 258(4): 192-197.
[9] Ariyan S.Functional radical neck dissection[J]. Plast Reconstr Surg, 1980, 65(6): 768-76.
[10] 李少明, 高岭, 任文豪,等. 功能性与根治性颈淋巴清扫术在早期口腔鳞状细胞癌治疗中的疗效比较[J]. 上海口腔医学, 2017, 26(3): 305-308.
[11] 周正炎. 功能性颈淋巴清扫术[J].口腔颌面外科杂志,1992, 2(1):56-60.
[12] Nibu K, Ebihara Y, Ebihara M, et al.Quality of life after neck dissection: a multicenter longitudinal study by the Japanese Clinical Study Group on Standardization of Treatment for Lymph Node Metastasis of Head and Neck Cancer[J]. Int J Clin Oncol, 2010, 15(1): 33-38.
[13] Cuccia G, Shelley OP, D'alcontres FS, et al. Evidence of significant sternocleidomastoid atrophy following modified radical neck dissection type Ⅲ[J]. Plast Reconstr Surg, 2006, 117(1): 227-232.
[14] Ohtawa T, Katagiri M, Harada T.A study of sternocleidomastoid muscular atrophy after modified neck dissection[J]. Surg Today, 1998, 28(1): 46-58.
[15] Yang H, Diao LQ, Shi M, et al.Efficacy of intensity-modulated radiotherapy combined with chemotherapy or surgery in locally advanced squamous cell carcinoma of the head-and-neck[J]. Biologics, 2013, 7: 223-229.
[16] Bernier J, Domenge C, Ozsahin M, et al.Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer[J]. N Engl J Med, 2004, 350(19): 1945-1952.
[17] Cooper JS, Pajak TF, Forastiere AA, et al.Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck[J]. N Engl J Med, 2004, 350(19): 1937-1944.