淋巴结清扫及采样在临床N0期NSCLC手术中的意义

目的：研究临床分期为N0的NSCLC术后淋巴结转移情况与术后生存率之间的差异，探讨临床分期为N0的NSCLC纵隔淋巴结清扫或采样的必要性。方法：回顾1985年1月～2000年6月手术切除的术前判断为N0的手术病例，对比术后淋巴结转移情况，判断术前cTNM与pTNM的偏差，以及患者生存率的变化。结果：本组cTNM分期总的准确率为42．32％（201／475），临床Ⅰ期的NSCLC（cT1N0M0、cT2N0M0）中出现N1或N2淋巴结转移的病例（pT1N1M0、pT1N2M0、pT2N1M0、pT2N2M0）与未出现转移的病例（pT1N0M0、pT2N0M0）之间的生存率之间差异显著，P〈0．01。本组cT3N0M0与pT3N1M0、p％N2M0之间生存率差异不明显。结论：尽管临床Ⅰ期的NSCLC（cT1N0M0、cT2N0M0）临床上无淋巴结转移证据，但由于临床分期与术后病理分期客观上存在差异，淋巴结清扫及采样仍是必要的，任何不能行淋巴结清扫的肿瘤局部治疗方法都可能是不充分的。     

pT2-3N0-1M0期胸段食管鳞癌根治术患者的预后分析

目的 探讨pT2-3N0-1M0期胸段食管鳞癌患者根治术后的远期生存情况及其影响因素。方法收集南京医科大学第二附属医院2011年1月至2014年3月经手术病理证实的pT2-3N0-1M0期胸段食管鳞癌127例初治患者的临床及随访资料。采用单因素Kaplan Meier法和多因素Cox风险比例回归模型分析127例接受根治手术患者的总生存期（OS）及其影响因素,应用列线图模型实现对患者个体1、3、5年生存率的数值预估。结果 127例患者术后的1、3、5年生存率分别为81.8％、54.3％、38.4％,中位OS为40.0个月（95％CI：32.285～47.715个月）。Cox多因素分析显示,pT分期（pT2、pT3）、pN分期（pN0、pN1）、有无脉管瘤栓、肿瘤直径（≤3 cm、＞3 cm）是影响根治切除术后OS的独立因素,pT3、pN1、有脉管瘤栓和肿瘤直径＞3 cm分别较对应项的生存期缩短,风险倍数分别为2.207、2.157、1.758和1.607倍（均P＜0.05）。构建的列线图模型能够准确预测pT2-3N0-1M0期胸段食管鳞癌个体根治术后的生存率。结论 pT2-3N0-1M0期胸段食管鳞癌患者根治术后的1、3、5年生存率明显下降,预后差,其生存预后与浸润深度、淋巴结转移、脉管瘤栓、肿瘤直径4个因素密切相关,值得临床继续深入研究。     

鼻咽癌T3N0-1M0期单纯放疗和同期放化疗疗效回顾分析

 目的　回顾分析T3N0~1M0期鼻咽癌患者临床资料,探讨单纯放射治疗与同期放化疗两种治疗方式与预后的关系。方法　中山大学肿瘤防治中心2004年1月至12月收治的经病理学证实的初治鼻咽癌患者781例,均有完整鼻咽和颈部MRI资料,且均无远处转移。按照2008中国鼻咽癌分期标准重新分期,82例行单纯放疗或同期放化疗的T3N0~1M0期患者入组,分为单纯放疗（A组）46例,同时期放化疗（B组）36例。结果　两组患者的临床资料具有可比性,单因素分析显示A组和B组的5年总生存（OS）率分别为93.5 %和100 %（P＝0.046）,5年无瘤生存（DFS）率分别为85.2 %和91.7 %（P＝0.498）。N分期是鼻咽癌DFS的影响因素（P＝0.026）。分层分析显示：T3N0M0期患者A组和B组5年OS率分别为94.7 %和100 %（P＝0.432）;T3N1M0期A组和B组5年OS率分别为92.6 %和100 %（P＝0.066）;T3N1M0期A组和B组5年DFS率分别为73.7 %和89.3 %（P＝0.244）。多因素分析显示,同期放化疗不是 T3N0~1M0期鼻咽癌患者OS的独立预后因素（HR＝0.019;95 % CI 0～21.793）,N分期不是影响T3N0~1M0期鼻咽癌患者DFS的独立预后因素（HR＝0.203;95 % CI 0.135～1.231×104）。结论　T3N0M0期患者同期放化疗与单纯放疗疗效无差异, T3N1M0期患者行同期放化疗能否改善生存有待进一步研究。     

pT3N0M0期胸段食管鳞癌根治术后的预后因素

目的 探讨pT3N0M0期胸段食管鳞癌两野根治术后的预后及其影响因素。方法 胸段食管鳞癌行胸腹两野食管癌根治术后、分期为pT3N0M0者249例,中位年龄60岁（33~78岁）;胸上段39例、胸中段166例、胸下段44例,病变中位长度5 cm（2~12 cm）;术中无粘连者35例、轻度粘连者90例、重度粘连者124例;术中清扫淋巴结中位数9枚（1~27枚）;98例单纯手术、151例行术后辅助治疗。结果 249例中1、3、5年总生存率（overall Survival, OS）和无进展生存率（progression-free survival, PFS）分别为90.0%、68.7%、55.2%和82.1%、61.7%、5 3 . 9%。单因素分析结果显示：性别、肿瘤位置、病理分化程度和术前血红蛋白水平与O S 有关（P<0.05）;年龄、肿瘤位置和术中粘连程度与PFS有关（P<0.05）;多因素分析结果显示：肿瘤位置、术前血红蛋白水平、术前CT有纵隔小淋巴结（<1 cm）和清扫淋巴结数目是OS独立影响因素,肿瘤位置是影响PFS独立危险因素。术后辅助治疗对OS和PFS均无明显影响;但术前CT纵隔有小淋巴结（<1 cm）者,术后辅助治疗可以提高OS和PFS（P<0.05）。结论 pT3N0M0期胸段食管鳞癌胸腹两野根治术后,肿瘤位置影响OS和PFS,胸下段癌预后最好,胸上段癌预后最差;术中清扫淋巴结数多、术前CT纵隔无淋巴结者预后较好,反之预后较差;术前血红蛋白高者生存率低;而术后辅助治疗的价值有待证实。     

阴性淋巴结数目预测胃癌术后生存的临床价值

目的:评价局部进展期胃癌根治术后区域阴性淋巴结数目对术后无瘤生存期（disease free survival,DFS）的影响。方法:选取有明确术后病理资料且术后病理分期为T3N0～2M0、随访资料完整、术后无瘤生存时间超过6 个月的根治术后胃癌患者共485 例,按照不同术后病理分期进行单独分组分析。Cox 多因素回归分析筛选影响术后无瘤生存的因素,Kaplan-Meier 方法绘制术后无瘤生存曲线,并比较各组中无瘤生存率间的差异。结果:Cox 多因素回归分析表明,独立影响胃癌患者术后无瘤生存期的因素包括年龄、肿瘤分化程度、肿瘤部位以及术后病理中阴性淋巴结数目。在T3N0M0 组中,当阴性淋巴结分别为1～4 枚和≥5 枚时,患者2 年无瘤生存率分别为8.3% 和55.6% ,3 年无瘤生存率分别为0 和24.9%（P=0.025）;在T3N1M0 组中,当阴性淋巴结分别为≤3 枚、4～9 枚和≥10枚时,患者2 年无瘤生存率分别为17.3% 、39.1% 和52.6% ,3 年无瘤生存率分别为4.2% 、6.0% 和17.1%（P<0.001）;在T3N2M0 组中,当阴性淋巴结为≤7 枚和≥8 枚时,患者2 年无瘤生存率分别为11.5% 和35.0% ,3 年无瘤生存率分别为0.8% 和5.0%（P=0.015）。 结论:对于术后病理分期为T3N0～2M0 的胃癌病例,术后病理资料中阴性淋巴结数目可反映区域淋巴结清扫的彻底性以及评价术后病理分期的准确性,是影响根治术后无瘤生存期的独立预后因素。      

乳腺癌腋窝淋巴结清扫术后阴性淋巴结数目的临床意义

目的：评价早期乳腺癌行腋窝清扫术后阴性淋巴结数目对术后生存的影响。方法：选取病历资料和随访完整的T1-2N0-1M0早期乳腺癌患者,按照淋巴结转移情况分成2组,每组进一步按照阴性淋巴结数目进行分层。将阴性淋巴结数目纳入Cox回归分析影响术后生存的病理学因素,并且比较不同阴性淋巴结数Et对患者术后生存的影响。结果：Cox回归分析显示影响乳腺癌术后生存的病理学因素包括阴性淋巴结数目和激素受体表达。在T1-2N0组,阴性淋巴结数目分别为≤3枚,4枚～5枚,6枚～9枚,≥10枚时,术后中位生存期分别为（82．6±4．1）月、（101．5±1．3）月、（104．7±1．0）月、（110．5±0．9）月;在T1-2N1组,阴性淋巴结数目分别为≤6枚,7枚-8枚,9枚-10枚,≥11枚时,术后中位生存期分别为（95．4±1．9）月、（101．8±1．1）月、（104．9±1．0）月、（106．5±0．9）月;两组差异具有统计学意义（P〈0．05）。结论：早期乳腺癌行腋窝清扫术后的阴性淋巴结数目反映淋巴结清扫的彻底性,是乳腺癌术后生存的独立影响因素,能够评价乳腺癌术后分期的准确性。     

术后放疗对T1-2N1M0期三阴乳腺癌患者预后的影响

目的 分析T1-2N1M0期三阴性乳腺癌（TNBC）患者行改良根治术后放疗与否对生存的影响。方法 回顾性分析2004年1月至2010年9月接受改良根治术后129例T1-2N1M0期TNBC患者的临床资料,其中61例行术后常规放疗（放疗组）,68例未行放疗（未放疗组）。分析两组5年总生存率、5年无局部复发生存率和5年无病生存率以及影响局部复发的因素。结果 中位随访时间为67个月,全组患者中27例（20.9％）出现局部区域复发。放疗组较未放疗组提高了5年无局部复发生存率（88.5％ vs. 70.6％,P=0.017）和5年无病生存率（78.7％ vs.63.2％, P=0.068）。放疗组和未放疗组的5年生存率分别为88.5％和82.4％（P=0.341）。单因素分析显示年龄、T分期、淋巴结阳性数、是否放疗是影响无局部复发生存的预后因素（P＜0.05）。多因素分析显示未放疗（HR=3.432,P=0.010）和淋巴结3枚阳性（HR=2.915,P=0.020）是影响局部区域复发的独立预后因素。结论 术后放疗可明显改善T1-2N1M0期TNBC患者的无局部复发生存。淋巴结3枚阳性者局部控制更差,增加区域淋巴结照射是可行的。     

N0～1乳腺癌腋窝淋巴结清扫预后分析

[目的]探讨N0～1乳腺癌腋窝淋巴结清扫范围、数目与预后的关系.[方法]回顾性分析102例N0～1乳腺癌手术病例,分析腋窝淋巴结清扫范围、数目、淋巴结转移数与5年生存率关系.[结果]不全腋清组与全腋清组5年生存率分别为68.57%、79.92%(X2=2.240,P=0.135),腋淋巴结清扫数＜10个组与腋淋巴结清扫数≥10个组5年生存率分别为72.79%、86.96%(X2=1.343,P=0.247);腋淋巴结转移≥4个与＜4个的5年生存率分别为48.57%、85.33%(X2=9.373,P=0.002);在腋淋巴结清扫数≥10个组中,腋淋巴结转移≥4个与＜4个的5年生存率分别为48.74%、83.33%(X2=6.398,P=0.011).[结论]本研究未能提示N0～1乳腺癌腋窝淋巴结清扫范围、数目影响预后,但腋淋巴结转移数目影响预后;腋淋巴结清扫数应≥10个,可准确判断预后.     

T1~2N0M0期乳腺癌改良根治术后胸壁复发的危险因素分析

摘 要：［目的］ 探索早期乳腺癌胸壁复发的危险因素。［方法］ 收集2005年8月至2016年3月我院收治的乳腺癌患者的临床资料,入组条件：术后分期T1N0M0、T2N0M0,清扫淋巴结总数≥10枚;且未行术后辅助放射治疗,共入组337例;其中首发转移部位为胸壁者共48例。［结果］ 单因素分析显示,原发灶大小、癌周血管侵犯、组织学分级、ER/PR表达、内分泌治疗等不同亚组在胸壁复发之间有统计学意义（P<0.05）。Logistic回归多因素分析显示,癌周血管侵犯（+）、组织学分级Grade 3与T1～2N0M0期乳腺癌术后胸壁复发相关（P<0.05）。［结论］ 乳腺癌术后分期T1～2N0M0的患者中,癌周血管侵犯（+）、组织学分级Grade 3为术后胸壁复发的独立危险因素,此类患者行术后辅助放疗有可能临床获益。     

T1micN0M0、T1aN0M0和T1bN0M0乳腺癌376例临床特征和预后分析

目的:分析T1micN0M0、T1aN0M0和T1bN0M0乳腺癌患者的临床病理学特征,了解其生存状态,探讨与预后相关的独立影响因素。方法:收集2002年1月—2005年12月4487例可手术的乳腺癌患者的临床病理学资料,回顾性分析其中376例T1micN0M0、T1aN0M0和T1bN0M0患者的临床病理学特征、复发和转移以及生存情况。结果:376例患者中,66例(17.6%)为T1mic(pT≤0.1cm),122例(32.4%)为T1a(0.1cm相似文献   

Late mortality from pT1N0M0 breast carcinoma.

BACKGROUND: pT1N0M0 breast carcinoma (< or = 2 cm in greatest dimension, lymph node negative) is associated with generally favorable 5-year and 10-year survival, but to the authors' knowledge there are few data available regarding the long term outcome of these patients. METHODS: The authors identified women with breast carcinoma diagnosed between 1945-1984 in a geographically defined urban population using the files of the Finnish Cancer Registry and local hospital records (n = 1495). The clinical and autopsy records and histologic slides were reviewed. The series contained 265 patients with unilateral pT1N0M0 breast carcinoma treated with mastectomy and axillary lymph node dissection without adjuvant systemic therapy and who were followed for 10-44 years (median, 17 years) after the initial diagnosis or until death. RESULTS: The last death from pT1N0M0 breast carcinoma occurred 23 years after the initial diagnosis. The 20-year overall survival rate was 54% (95% confidence interval [95% CI], 48-60%) and the survival rate when corrected for intercurrent deaths was 81% (95% CI, 75-87%). The 20-year survival rate when corrected for intercurrent deaths was 92% (95% CI, 86-98%) in patients with T1a-b disease (primary tumor < or = 10 mm), but was only 75% (95% CI, 64-86%) in patients with pTc disease (range, 11-20 mm). None of the patients with well differentiated (World Health Organization Grade 1) pTa-b tumors died of breast carcinoma (n = 48) whereas the 20-year survival rate when corrected for intercurrent deaths was 81% (95% CI, 67-95%) in patients with Grade 2-3, pT1a-b tumors (P = 0.002). CONCLUSIONS: Patients with well differentiated pT1a-b tumors form a subgroup with excellent long term prognosis, but a significant proportion of women with either moderately or poorly differentiated pT1a-b tumors or pT1c tumors ultimately die of the disease.     

Clinicopathological value of immunohistochemical detection of occult involvement in pT3N0 gastric cancer

Background. In cases of pT3 gastric cancer, even when standard histological staining reveals no evidence of metastases in the regional lymph nodes, patients still may die of postoperative recurrence of the tumor. An attempt was made in the present study to explain the unfavorable outcome of such patients by investigating the presence of occult cancer cells in lymph nodes by immunostaining of cytokeratin. Methods. We examined 2310 lymph nodes that had been removed from 83 patients with stage II gastric cancer (pT3, N0, M0). Two consecutive sections of 4 μm thick were prepared for simultaneous staining with hematoxylin and eosin and immunostaining with the CAM 5.2 monoclonal antibody against cytokeratin, respectively. Results. Evidence of occult involvement was found in 299 of 2310 (13%) lymph nodes and in 54 of 83 (65%) patients with pT3 gastric cancer. An analysis of survival demonstrated the limited 5-year survival of patients with occult involvement in their resected lymph nodes, as compared with that of patients without involvement (P < 0.01). Moreover, the patients in whom group 2 lymph nodes had occult cancer cells had a significantly poorer prognosis than those in whom occult involvement was limited to group 1 lymph nodes (P < 0.05). Conclusions. The accuracy of predictions of prognosis of patients with pT3 gastric cancer should be greatly enhanced if cytokeratin-specific immunostaining is performed in conjunction with routine histopathological examination of lymph nodes. Received for publication on Dec. 24, 1998; accepted on March 31, 1999     

Prognostic Significance of the Number of Negative Lymph Nodes in Postoperative Locally Advanced Gastric Cancer Patients

OBJECTIVE To evaluate the impact of the number of negative lymph nodes on disease free survival (DFS) in patients with locally advanced gastric cancer.METHODS A total of 485 patients who underwent surgery for locally advanced gastric cancer (pT3N0-2M0) and had a DFS at least 6 months were enrolled in this retrospective study. The medical records of the patients were reviewed in detail, and the characteristics of the patients and the findings of pathologic examination were analyzed in order to find the potential association with DFS. Subgroup analysis according to pathologic stage was performed. Multivariate analysis using the COX regression method was also conducted in order to identify the independent prognostic factors. The Kaplan-Meier method was used to plot DFS curves. The DFS rate was compared in each subgroup.RESULTS COX regression analysis showed that the DFS rate of gastric cancer patients with pathologic stage T3N0-2M0 was significantly associated with age, degree of tumor differentiation, tumor location as well as the number of negative lymph nodes. Among patients with stage T3N0M0 disease, who had 1-4 and 5 or more negative lymph nodes, the 2-year DFS rate was 8.3% and 55.6%, respectively. Meanwhile, the 3-year DFS rates of the same group of patients was 0% and 24.9%, respectively (P = 0.025). In the T3N1M0 subgroup, the 2-year DFS rate of patients with 3 or fewer, 4-9, and 10 or more negative lymph nodes was 17.3%, 39.1%, 52.6%, respectively. The 3-year DFS rate in this group was 4.2%, 6.0%, 17.1%, respectively (P < 0.001). In the T3N2M0 subgroup, the 2-year DFS rate of patients with 7 or fewer and 8 or more negative lymph nodes was 11.5% and 35%, respectively. The 3-year DFS rate of the same group of patients with 8 or more negative lymph nodes was also significantly improved (0.8% vs. 5%, respectively; P = 0.015).CONCLUSION For gastric cancer patients with pathologic stage T3N0-2M0, the number of negative lymph nodes is an independent prognostic factor for DFS. The number of negative lymph nodes may reflect the level of regional lymph node dissection or the accuracy of the pathologic staging.     

cT1-2N1M0期乳腺癌新辅助化疗和改良根治术后腋窝淋巴结转移0~3枚患者术后放疗的生存分析

目的探讨cT1-2N1M0期乳腺癌新辅助化疗和改良根治术后达到腋窝淋巴结转移0~3枚的患者行术后放疗的价值。方法回顾性分析2000年1月1日至2014年12月31日本院收治的128例临床诊断为T1-2N1M0期乳腺癌患者的临床资料,所有患者均完成新辅助化疗和改良根治手术,术后腋窝淋巴结转移数为0~3枚。根据有无术后放疗将患者分为放疗组(n=87)和未放疗组(n=41),两组术后腋窝淋巴结转移达1~3枚(ypN1)患者分别为43、11例,术后腋窝淋巴结转移0枚(ypN0)患者分别为44、30例。采用Kaplan-Meier法计算患者5年无局部/区域复发生存(LRFS)率、无瘤生存(DFS)率和总生存(OS)率,并进行log-rank检验,单因素分析患者临床特征和治疗对预后的影响。结果128例患者的5年LRFS率、DFS率和OS率分别为91.4%、82.8%和93.0%。放疗组和未放疗组患者的5年LRFS率分别为94.3%和85.4%,差异无统计学意义(χ^2=3.055,P=0.080);5年DFS率分别为89.7%和68.3%,差异有统计学意义(χ^2=9.312,P=0.005);5年OS率分别为94.3%和90.2%,差异无统计学意义(χ^2=0.810,P=0.368)。亚组分析中,放疗组和未放疗组术后达ypN1患者的5年LRFS率分别为93.0%和72.7%,差异有统计学意义(χ^2=4.248,P=0.039);5年DFS率分别为88.4%和63.6%,差异有统计学意义(χ^2=4.525,P=0.033);5年OS率分别为90.7%和81.8%,差异无统计学意义(χ^2=0.713,P=0.399)。放疗组和未放疗组患者术后ypN0患者的5年LRFS率分别为95.5%和90.0%,差异无统计学意义(χ^2=0.872,P=0.350);5年DFS率分别为90.9%和70.0%,差异有统计学意义(χ^2=5.439,P=0.019);5年OS率分别为97.7%和93.3%,差异无统计学意义(χ^2=0.876,P=0.349)。单因素分析结果显示,年龄(χ^2=11.709,P=0.001)和有无脉管瘤栓(χ^2=7.608,P=0.006)是5年LRFS的影响因素,有无术后放疗(χ^2=9.312,P=0.002)是5年DFS的影响因素,年龄(χ^2=6.093,P=0.014)和激素受体状态(χ^2=3.974,P=0.046)是OS的影响因素。结论cT1-2N1M0期乳腺癌经新辅助化疗和改良根治术后ypN1的患者,行术后放疗有局部控制获益,并能改善患者DFS;而cT1-2N1M0期乳腺癌经新辅助化疗和改良根治术后ypN0的患者,术后放疗价值仍需进一步研究。     

Ⅲ期N2非小细胞肺癌的外科治疗

目的：探讨Ⅲ期N2非小细胞肺癌（NSCLC）患者外科治疗的疗效及影响预后的因素。方法：回顾性分析1982－1996年手术治疗的266例Ⅲ期N2 NSCLC患者的5年生存率,与同期手术的N0、N1患者做比较,用Cox模型分析病理分型、淋巴结转移数目、淋巴结转移区域、手术方式、T状态、手术性质等对N2的NSCLC患者预后的影响。结果：266例Ⅲ期N2的NSCLC患者的5年生存率为17．3％,明显低于同期N0、N1患者的5年生存率（51．4％和30．4％）,淋巴结转移数目、淋巴结转移区域、T状态、手术性质为影响预后的重要因素。结论：对单区域纵隔淋巴结转移且估计能完全切除的Ⅲ期N2（特别是T1）NSCLC应采取以手术为主的综合治疗。     

YpT1-2N0 rectal cancer after neoadjuvant chemoradiation has lower survival compared with pT1-2N0 rectal cancer

Pathologic T1-2N0 rectal cancer shows an excellent prognosis without preoperative or postoperative chemoradiation. However, oncologic outcome of ypT1-2N0 remains unclear and undetermined. Thus, the aim of this study was to compare the survival of ypT1-2 and pT1-2 rectal cancer patients after radical resection and identify risk factors of ypT1-2 rectal cancer in Surveillance, Epidemiology, and End Results Program (SEER)-registered rectal cancer patients. The results showed that ypT1-2N0 rectal cancer after neoadjuvant chemoradiation has lower survival compared with pT1-2N0 rectal cancer and mucinous/signet-ring cancer and less than 12 lymph nodes retrieval were two risk factors in ypT1-2 patients. These results suggest that ypT1-2 patients with one or two risk factors may benefit from postoperative adjuvant chemotherapy.     

Survival in squamous cell carcinoma of the oral cavity: differences between pT4 N0 and other stage IVA categories

BACKGROUND: According to the American Joint Commission on Cancer (AJCC, 5(th) edition) classification system, pT4 N0 oral cavity squamous cell carcinoma (OSCC) qualifies for stage IVA status, with its implied poor prognosis. However, preliminary observations suggested that patients with pT4 N0 OSCC might have better survival than other stage IVA categories. The authors sought to identify accurate prognosticators in patients with stage III/IVA OSCC. METHODS: The authors retrospectively reviewed 513 consecutive patients with stage III/IVA OSCC who were undergoing radical surgery. Survival was plotted by Kaplan-Meier analysis. RESULTS: One hundred seventy-eight patients were in stage III, and 335 were in stage IVA. The 335 stage IVA patients were divided into pT4 N0 (n = 105) and pT4 N1/TAny N2 (NO pT4 N0 M0, n = 230). By univariate analysis, 5-year neck control rates (P < .0001), distant metastases (P < .0001), disease-free survival rates (P < .0001), and overall survival rates (P < .0001) were significantly different in pT4 N0 compared with NO pT4 N0 patients. No significant difference in survival between pT4 N0 stage IVA and pstage III could be shown. Multivariate analysis for overall survival demonstrated that the following factors were independently associated with pT4 N0: tumor depth >or=35 mm, vessel invasion, lymph invasion, and perineural invasion. In contrast, tumor depth >or=25 mm, treatment with surgery alone, poor differentiation, extracapsular spread, and pathological nodal metastases (>or=8 lymph nodes) were independent predictors of overall survival in NO pT4 N0. CONCLUSIONS: In patients with stage IVA OSCC (AJCC, 1997), the survival rates for pT4 N0 are better than those for NO pT4 N0 and similar to those of patients with pstage III.