Clinical oral investigations · 2026
Synergistic predictive value of T-stage and lymph node yield in guiding adjuvant radiotherapy decisions for pN1 OSCC without high-risk features: a multi-institutional retrospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Li Bo, Huang Yu, Zhou Hanchen, Guo Chuanbin, Wei Wei, Cao Wei, Feng Zhien
Аннотация
OBJECTIVES: This study aimed to identify a subset of patients with pN1 oral squamous cell carcinoma (OSCC) and no adverse pathological features who derive significant benefit from adjuvant radiotherapy (RT).
MATERIALS AND METHODS: In this multicenter retrospective study, 232 eligible pN1 OSCC patients were analyzed. Patients were stratified by T-stage (T1-2 vs. T3-4) and lymph node yield (LNY; high: ≥20; low: <20). The impact of adjuvant RT on survival outcomes was evaluated.
RESULTS: A significant survival benefit from adjuvant RT was observed exclusively in the subgroup with advanced T-stage (T3-4) and low LNY (< 20), with improved disease-free survival (69.2% vs. 23.1%, p = 0.003), overall survival (76.9% vs. 38.5%, p = 0.012), and disease-specific survival (80.8% vs. 46.2%, p = 0.014). In contrast, no significant survival differences were found in the other T-stage/LNY subgroups. Furthermore, LNY alone did not independently predict prognosis or RT benefit in the overall cohort.
CONCLUSIONS: This retrospective study suggests that pN1 OSCC patients with T3-4a stage disease and a low LNY (LNY < 20, levels I-III) may represent a subgroup that derives benefit from adjuvant RT. These exploratory findings suggest a practical model that warrants prospective validation to guide personalized therapy.
CLINICAL RELEVANCE: This study provides clinical evidence to help refine the postoperative management of pN1 OSCC patients without high-risk features. It provides a practical stratification tool to guide personalized treatment decisions, aiming to optimize survival outcomes while reducing unnecessary radiotherapy.
MATERIALS AND METHODS: In this multicenter retrospective study, 232 eligible pN1 OSCC patients were analyzed. Patients were stratified by T-stage (T1-2 vs. T3-4) and lymph node yield (LNY; high: ≥20; low: <20). The impact of adjuvant RT on survival outcomes was evaluated.
RESULTS: A significant survival benefit from adjuvant RT was observed exclusively in the subgroup with advanced T-stage (T3-4) and low LNY (< 20), with improved disease-free survival (69.2% vs. 23.1%, p = 0.003), overall survival (76.9% vs. 38.5%, p = 0.012), and disease-specific survival (80.8% vs. 46.2%, p = 0.014). In contrast, no significant survival differences were found in the other T-stage/LNY subgroups. Furthermore, LNY alone did not independently predict prognosis or RT benefit in the overall cohort.
CONCLUSIONS: This retrospective study suggests that pN1 OSCC patients with T3-4a stage disease and a low LNY (LNY < 20, levels I-III) may represent a subgroup that derives benefit from adjuvant RT. These exploratory findings suggest a practical model that warrants prospective validation to guide personalized therapy.
CLINICAL RELEVANCE: This study provides clinical evidence to help refine the postoperative management of pN1 OSCC patients without high-risk features. It provides a practical stratification tool to guide personalized treatment decisions, aiming to optimize survival outcomes while reducing unnecessary radiotherapy.