Predicting Residual Neck Disease in Patients With Oropharyngeal Squamous Cell Carcinoma Treated With Radiation Therapy Utility of p16 Status
Predicting Residual Neck Disease in Patients With Oropharyngeal Squamous Cell Carcinoma Treated With Radiation Therapy Utility of p16 Status
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DOI：
10.1001/archoto.2009.153
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发表时间：
2009-11-01
影响因子：
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通讯作者：
Jameson, Mark J.
中科院分区：
文献类型：
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作者：
Shonka, David C., Jr.;Shoushtari, Asal N.;Jameson, Mark J.
目的：确定口咽鳞状细胞癌（OP-SCCA）患者颈部淋巴结疾病对放射治疗（RT）完全反应的预测因素。设计：前瞻性收集标本的组织学分析和回顾性病历回顾。设置：三级转诊中心。受试者：2002年1月1日至2008年6月1日接受治疗的69例OP-SCCA患者。干预：repertive RT，有或无化疗和有或无颈淋巴结清扫术（ND）。主要结果Measure：存在一个可行的肿瘤在后RT ND specimen.Results：组织标本从69例OP-SCCA治疗主要与RT，有或无化疗，进行了评价。其中47例（68.1%）免疫组化显示p16强阳性和弥漫性阳性，提示人乳头瘤病毒阳性。p16阳性和p16阴性肿瘤患者（以下分别为p16+和p16-）的原发肿瘤大小相似，但p16+原发肿瘤与更晚期的颈部疾病（淋巴结分期N2 c-N3; p16-肿瘤31.9% vs 4.5%）和更多对侧淋巴结（p16-肿瘤27.7% vs 4.5%）相关。47例患者（59.0%）接受了计划的治疗后ND（共55例ND）。对p16-肿瘤进行的ND在标本中更有可能存在存活肿瘤（50.0% vs p16+肿瘤的18.0%; P = 0.02）。此外，p16+颈部残留的可行的癌症的特点是不完全反应后RT成像，烟草和酒精的使用，和pretreatmentimaging.Conclusions囊外传播结合其他临床参数，p16状态可以帮助预测需要后RT ND在OP-SCCA患者。尽管在选定的p16+肿瘤患者中可能需要密切观察，但p16-肿瘤患者发生颈部残留疾病的风险要高得多，即使最初的淋巴结疾病不太严重。
Objective: To identify factors that predict complete response of cervical nodal disease to radiation therapy (RT) in patients with oropharyngeal squamous cell carcinoma (OP-SCCA).Design: Histologic analysis of prospectively collected specimens and retrospective medical chart review.Setting: Tertiary referral center.Subjects: Sixty-nine patients with OP-SCCA treated from January 1, 2002, through June 1, 2008.Intervention: Definitive RT, with or without chemotherapy and with or without neck dissection (ND).Main Outcome Measure: Presence of a viable tumor in post-RT ND specimen.Results: Tissue specimens from 69 patients with OP-SCCA treated primarily with RT, with or without chemotherapy, were evaluated. Of these, 47 (68.1%) were strongly and diffusely positive for p16 expression by immunohistochemical analysis, signifying human papillomavirus positivity. Patients with p16-positive and p16-negative tumors (hereinafter, p16+ and p16-, respectively) had similarly sized primary tumors on presentation, but p16+ primary tumors were associated with more advanced neck disease (nodal stages N2c-N3; 31.9% vs 4.5% for p16- tumors) and more contralateral nodes (27.7% vs 4.5% for p16- tumors). Forty-seven patients (59.0%) underwent planned posttreatment ND (a total of 55 NDs). The NDs performed for p16- tumors were significantly more likely to have viable tumor in the specimen (50.0% vs 18.0% for p16+ tumors; P = .02). In addition, p16+ necks with residual viable cancer were characterized by incomplete response on post-RT imaging, tobacco and alcohol use, and extracapsular spread on pretreatment imaging.Conclusions: In conjunction with other clinical parameters, p16 status can help predict the need for post-RT ND in patients with OP-SCCA. Although close observation may be warranted in selected patients with p16+ tumors, patients with p16- tumors are at much higher risk for residual neck disease, even when initial nodal disease is less advanced.