Nodale Metastasierung und Stellenwert der Neck Dissection bei T1/2-Oro- und Hypopharynxkarzinomen

Zusammenfassung

Hintergrund

Die Indikation zur elektiven Neck Dissection (END) bei Patienten mit T1/2-Plattenepithelkarzinomen des Hypopharynx (HPSCC) und Oropharynx (OPSCC) wird nicht einheitlich gestellt. In der vorliegenden Studie erfolgte daher eine detaillierte Analyse des Metastasierungsverhaltens von HPSCC und OPSCC.

Material und Methoden

Es erfolgte eine multizentrische retrospektive Analyse des nodalen Metastasierungsverhaltens und der onkologischen Parameter von 262 chirurgisch therapierten HPSCC- und OPSCC-Patienten. Zudem erfolgte eine systematische Literaturrecherche.

Ergebnisse

Bei HPSCC-Patienten lag in 62,1% der Fälle eine Diskrepanz zwischen klinischem und pathologischem N-Status vor, bei OPSCC in 52,4% (p16-) bzw. 43,6% (p16+). Die okkulte Metastasierungsrate in den Primärtumorstadien T1/2 lag dabei bei 38,9% für HPSCC und bei 17,8% (p16-) und 11,1% (p16+) für OPSCC. Bei HPSCC traten in den Stadien cT1/2cN0 in 22,2% der Fälle kontralaterale Metastasen auf; die Rate bei OPSCC lag bei lediglich 9,1% (p16-) bzw. 0% (p16+). Patienten mit p16-positiven OPSCC wiesen ein besseres rezidivfreies und Gesamtüberleben auf als p16-negative OPSCC- und HPSCC-Patienten. Ein direkter Zusammenhang zwischen Patientenüberleben und Ausmaß der chirurgischen Therapie des Halses ließ sich nicht nachweisen.

Schlussfolgerung

Patienten mit HPSCC weisen ab Stadium cT1/2cN0 ein hohes Risiko für okkulte Halslymphknotenmetastasen auf, welches die Durchführung einer beidseitigen END rechtfertigt. Bei Patienten mit T1/2cN0-OPSCC manifestieren sich ipsilateral in >20% der Fälle okkulte Metastasen; das Risiko für eine kontralaterale okkulte Metastasierung liegt jedoch bei <10%, sodass bei streng lateralisierten Tumoren ein Verzicht auf die kontralaterale Neck Dissection erwogen werden kann.

Abstract

Background

Due to heterogeneous data, the indication for elective neck dissection (END) in patients with squamous cell carcinoma of the hypopharynx and oropharynx (HPSCC and OPSCC) in stages T1/2N0 is somewhat unclear. Therefore, in this multicenter study, we performed detailed analysis of the metastatic behavior of HPSCC and OPSCC.

Material and Methods

The nodal metastatic patterns of 262 HPSCC and OPSCC patients who had undergone surgery was retrospectively investigated. In addition, recurrence-free and overall survival were recorded. Furthermore, a systematic literature review on the topic was completed.

Results

In patients with HPSCC, a discrepancy between clinical and pathologic N status was recorded in 62.1% of patients vs. 52.4% for p16- OPSCC, and 43.6% for p16+ OPSCC. The occult metastasis rate in cT1/2cN0 primary tumors was 38.9% for HPSCC vs. 17.8% (p16- OPSCC) and 11.1% (p16+ OPSCC). Contralateral metastases occurred in 22.2% of cases for HPSCC at stages cT1/2cN0, compared to only 9.1% for p16- OPSCC, and 0% for p16+ OPSCC patients.

Patients with p16+ OPSCC had better recurrence-free and overall survival than p16- OPSCC and HPSCC patients. A direct association between patient survival and the extent of neck surgical therapy could not be demonstrated in our patients.

Conclusion

Patients with HPSCC are at risk for bilateral neck metastases from stage cT1/2cN0, justifying bilateral END. Patients with T1/2 OPSCC present with occult metastases ipsilaterally in >20% of cases; however, the risk for contralateral occult metastasis is <10%. Hence, in strictly lateralized cT1/2CN0 tumors, omission of contralateral END may be considered.

Schlüsselwörter

Oropharynxkarzinom - Hypopharynxkarzinom - okkulte Metastasen - elektive Neck Dissection

Keywords

OPSCC - HPSCC - p16 - cT1/2 cN0 - elective neck dissection - END - early stage

Publication History

Received: 13 November 2023

Accepted after revision: 27 February 2024

Article published online:
03 March 2025

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