本研究旨在开发并内部验证预后列线图，用于预测颈部淋巴结临床阴性的早期口腔鳞状细胞癌 (OSCC) 患者的淋巴结无复发生存期 (NRFS)。早期口腔癌患者的治疗颈部淋巴结临床阴性（cN0）仍存在争议，特别是关于是否需要选择性颈部清扫术。利用单个机构 2010 年至 2020 年的数据来开发和评估列线图。使用多变量 Cox 回归和 LASSO 回归分析构建列线图，以确定淋巴结转移的独立危险因素。使用引导重采样进行内部验证，以评估列线图的预测准确性。总共 930 名 cN0 T1 和 T2 期 OSCC 患者被随机分为训练组和验证组（比例为 8:2）。淋巴结转移的独立危险因素包括肿瘤病理分级（良好：参考，中/差：OR 1.69），cT（cT1：参考，cT2：OR 2.01），饮酒史（从未：参考，当前/以前：OR 1.72 ）和侵入深度（0 mm < DOI ≤ 5 mm：参考，5 mm < DOI ≤ 10 mm：OR 1.31）。包含这些变量的列线图在验证集中表现出良好的预测准确性，C 指数为 0.67（95% CI：0.58-0.76）。在训练组和验证组中，列线图有效地将患者分为隐匿性颈部淋巴结转移的低风险组和高风险组（p< 0.05）。列线图能够进行风险分层并改进临床淋巴结阴性中隐匿性颈部淋巴结转移的识别通过结合肿瘤特异性和患者特异性风险因素来治疗 OSCC 患者。© 2024 John Wiley

This study aimed to develop and internally validate a prognostic nomogram for predicting nodal recurrence-free survival (NRFS) in patients with early-stage oral squamous cell carcinoma (OSCC) with clinically negative neck lymph nodes.The management of early-stage oral cancer patients with clinically negative neck lymph nodes (cN0) remains controversial, especially concerning the need for elective neck dissection. Data from a single institution spanning 2010 to 2020 were utilized to develop and evaluate the nomogram. The nomogram was constructed using multivariable Cox regression and LASSO regression analyses to identify independent risk factors for lymph node metastasis. Internal validation was performed using bootstrap resampling to assess the nomogram's predictive accuracy.A total of 930 cN0 patients with T1 and T2 stage OSCC were randomly divided into training and validation cohorts (8:2 ratio). Independent risk factors for lymph node metastasis included tumor pathological grade (well: reference, moderate/poor: OR 1.69), cT (cT1: reference, cT2: OR 2.01), history of drinking (never: reference, current/former: OR 1.72), and depth of invasion (0 mm < DOI ≤ 5 mm: reference, 5 mm < DOI ≤ 10 mm: OR 1.31). The nomogram, incorporating these variables, demonstrated good predictive accuracy with a C-index of 0.67 (95% CI: 0.58-0.76) in the validation set. In both training and validation groups, the nomogram effectively stratified patients into low-risk and high-risk groups for occult cervical nodal metastases (p < 0.05).The nomogram enables risk stratification and improved identification of occult cervical nodal metastases in clinically node-negative OSCC patients by incorporating tumor-specific and patient-specific risk factors.© 2024 John Wiley & Sons Ltd.