Number of nodal metastases and prognosis in metastatic cutaneous squamous cell carcinoma of the head and neck
Number of nodal metastases and prognosis in metastatic cutaneous squamous cell carcinoma of the head and neck
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DOI：
10.1111/ans.15086
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发表时间：
2019-07-01
影响因子：
1.7
通讯作者：
Ebrahimi, Ardalan
中科院分区：
文献类型：
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作者：
Sood, Ashish;Wykes, James;Ebrahimi, Ardalan
现有的头颈部转移性皮肤鳞状细胞癌（cSCCHN）的预后系统不能区分单个或多个淋巴结以外的受累淋巴结数量。本研究旨在确定转移性淋巴结的数量是否是转移性cSCCHN的独立预后因素，以及它是否为美国癌症联合委员会（AJCC）分期提供了额外的预后信息。方法我们回顾性分析了101例在澳大利亚悉尼利物浦医院通过手术+/-放疗进行腮腺和/或颈部淋巴结转移性cSCCHN根治性治疗的患者。采用多变量考克斯回归分析评估淋巴结转移数目对无病生存率（DFS）和远处转移风险的影响。结果淋巴结转移1-12个，平均2.5个。在多变量分析中，淋巴结转移数量的增加显著预测DFS的降低（危险比1.17; 95%置信区间1.05-1.30; P = 0.004），每增加一个淋巴结，复发或死亡的风险增加17%。这在AJCC第8版结节和TNM分期调整的多变量模型中仍然显着。淋巴结转移的数量也与远处转移失败的风险相关（风险比1.21; 95%置信区间1.05-1.39; P = 0.009）。结论转移性cSCCHN中淋巴结转移数量的增加与DFS降低和远处转移风险增加相关，每增加一个淋巴结，累积风险增加。它为AJCC分期提供了额外的预后信息，通过将淋巴结转移的数量信息纳入当前的单一与多重区分之外，可以改善AJCC分期。
Background Existing prognostic systems for metastatic cutaneous squamous cell carcinoma of the head and neck (cSCCHN) do not discriminate between the number of involved nodes beyond single versus multiple. This study aimed to determine if the number of metastatic lymph nodes is an independent prognostic factor in metastatic cSCCHN and whether it provides additional prognostic information to the American Joint Committee on Cancer (AJCC) staging. Methods We retrospectively analysed 101 patients undergoing curative intent treatment for metastatic cSCCHN to parotid and/or neck nodes by surgery +/- radiotherapy at Liverpool Hospital, Sydney, Australia. The impact of number of nodal metastases on disease-free survival (DFS) and risk of distant metastases was assessed using multivariate Cox regression. Results The mean number of nodal metastases was 2.5 (range 1-12). On multivariate analysis, increasing number of nodal metastases significantly predicted reduced DFS (hazard ratio 1.17; 95% confidence interval 1.05-1.30; P = 0.004), with a 17% increased risk of recurrence or death for each additional node. This remained significant in multivariate models adjusted for AJCC 8th edition nodal and TNM stages. Number of nodal metastases was also associated with risk of distant metastatic failure (hazard ratio 1.21; 95% confidence interval 1.05-1.39; P = 0.009). Conclusion Increasing number of nodal metastases is associated with decreased DFS and increased risk of distant metastases in metastatic cSCCHN, with a cumulative risk increase with each additional node. It provides additional prognostic information to the AJCC staging, which may be improved by incorporating information on the number of nodal metastases beyond the current single versus multiple distinction.