| Objective:Head and neck malignancies include those originating from mucous epithelium of oral cavity,pharynx,larynx and paranasal sinus,as well as those originating from glandular epithelium of major and minor salivary glands.Squamous cell carcinoma is the most common malignancy of epithelial origin.Regional lymph node metastasis is a prominent feature of Head and Neck Squamous Cell Carcinoma(HNSCC).Accurate assessment is key to the development and selection of treatment regimens.The 5-year survival rate of patients with cervical lymph node metastasis was lower than that of patients without metastasis.Lymph node status is so important to overall prognosis and treatment that the timing of neck dissection or radiotherapy remains controversial.In this study,the independent risk factors for cervical lymph node metastasis were screened out through the study and analysis of clinical,imaging and pathological features of HNSCC patients.The prediction model of cervical lymph node metastasis was constructed and verified internally.The risk stratification of cervical lymph node metastasis in HNSCC patients was carried out by using the nomographic score.The correlation between immunohistochemical results of primary tumor and lymph node metastasis was analyzed.Furthermore,the correlation between the primary tumor immunohistochemical results and the accuracy of preoperative CT imaging was analyzed.Methods:A retrospective analysis was performed on 272 patients with pathologically confirmed HNSCC admitted to the Affiliated Hospital of Qingdao University from June2017 to June 2021.According to postoperative pathological findings of cervical lymph nodes,patients were divided into the positive group and the negative group of cervical lymph node metastasis.Patients were randomly divided into a training set and a validation set in a ratio of 3:1.The diagnostic efficacy of preoperative cervical ultrasound and computed tomography(CT)in cervical lymph node metastasis of HNSCC patients was analyzed,and clinical,pathological and imaging data of the patients were collected.The data were gender,age,height,weight,Body Mass Index(BMI),lymph node length and diameter,lymph node length and diameter ratio,enhancement type,invasion of adjacent plane,lymph node aggregation,unilateral/bilateral,ultrasound lymph node capsule,lymphatic hilum,medulla,blood flow,echo,differentiation degree of primary tumor,length and diameter of primary tumor,Immunohistochemical results of primary tumor.Correlationanalysis was conducted between the above variables and cervical lymph node metastasis.Logistic regression analysis was performed on the meaningful variables and the independent risk factors screened were used to draw the nomogram of cervical lymph node metastasis and conduct internal verification.Draw Receiver operator characteristic curve(ROC),calibration curve and decision curve analysis(DCA).Another145 patients were selected to analyze the correlation between primary tumor immunohistochemical results and cervical lymph node metastasis.The correlation between the primary tumor immunohistochemical results and the accuracy of preoperative CT imaging was further analyzed.Results:1.A total of 272 HNSCC patients were included in this study to evaluate the diagnostic efficacy of preoperative cervical ultrasound and cervical enhanced CT in cervical lymph nodes.The diagnostic accuracy of the two was similar with no statistically significant difference(P>0.05).2.272 HNSCC patients were randomly divided into the training set and the validation set in a ratio of 3:1 and there was no statistical difference in clinical data between the two groups(P>0.05).In the training set,the clinical,pathological and radiological characteristics were included in the single-factor analysis and the differences in the ratio of length to diameter of lymph node,enhancement type,lymph node aggregation,medulla,lymphatic hilum,echo,blood flow,capsule and differentiation degree of primary tumor were statistically significant(P<0.05).3.The statistically significant factors in the training set were included in the multivariate regression model and lymph node length to diameter ratio,enhancement type,lymph nodes aggregation,medulla unclear/absent,lymph node heterogeneity echo,rich blood flow,primary tumor differentiation degree were the risk factors for cervical lymph node metastasis in HNSCC patients.Using Rstudio to construct nomogram model and to draw ROC curve and calibration curve.Area under the curve(AUC)of training set and verification set was 0.953 and 0.938 respectively.The average absolute error of calibration curve of training set and verification set was 0.021 and 0.024 respectively.The clinical decision curve showed that net benefit could be obtained when the probability of cervical lymph node metastasis predicted by the rosette was between 0.25 and 0.9 and the performance of the model was good.Risk stratification was carried out according to the score of the nomogram.Patients with a score>80 were considered to be in the high-risk group for cervical lymph node metastasis,and patients with a score≤80 were considered to be in the low-risk group for cervical lymph node metastasis.4.145 patients with complete primary tumor immunohistochemical results were screened from 272 HNSCC patients and the patients were divided into two groups: lymph node metastasis group and lymph node non-metastasis group.The correlation between immunohistochemical results and cervical lymph node metastasis were analyzed.The expression differences of Peripheral Nerve Invasion(PNI),CD31 and Ki67 in the two groups were statistically significant(P<0.05).5.The results of preoperative cervical lymph node CT imaging examination and postoperative cervical lymph node pathological examination of HNSCC patients were compared.According to the accuracy of preoperative CT imaging examination,145 patients were divided into false negative group and true negative group,false positive group and true positive group.The expression difference of CD31 between false negative group and true negative group was statistically significant(P<0.05),and the expression difference of Ki67 between false positive group and true positive group was statistically significant(P<0.05).Conclusion:1.The preoperative diagnosis accuracy of cervical lymph nodes in HNSCC patients with enhanced cervical CT and cervical ultrasound is high.2.The ratio of length to diameter of lymph nodes,enhancement type,lymph node aggregation,medulla unclear/absent,lymph node heterogeneity echo,rich blood flow,and differentiation degree of primary tumor were independent risk factors for cervical lymph node metastasis.This study established and verified the prediction of cervical lymph node risk in HNSCC patients.Risk stratification was performed according to the score of the nomogram.Patients with a score>80 were classified as the high-risk group for cervical lymph node metastasis and patients with a score≤80 were classified as the low-risk group for cervical lymph node metastasis.3.This study analyzed correlation between the pathological immunohistochemical results of the primary tumor and cervical lymph node metastasis.PNI,CD31 and Ki67 were significantly correlated with cervical lymph node metastasis.CD31 was correlated with false negative of preoperative CT imaging and Ki67 was correlated with false positive of preoperative CT imaging. |
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