Predictors of Mortality in HPV-Associated Oropharynx Carcinoma Treated With Surgery Alone-猫眼课题宝

DOI：

10.1002/lary.28344

发表时间：

2019-11-01

期刊：

LARYNGOSCOPE

影响因子：

2.6

通讯作者：

中科院分区：

医学2区

文献类型：

作者：

Han, Mary;Stanford-Moore, Gaelen B.;Ryan, William R.

目的人乳头瘤病毒相关口咽鳞状细胞癌(HPV+OPSCC)单纯手术治疗的生存结果尚不清楚。为了增加了解，我们使用国家癌症数据库(NCDB)评估了总体生存(OS)结果。方法采用单因素和多因素分析及Kaplan-Meir方法，对2010-2014年间736例NCDB HPV+OPSCC患者的临床资料进行回顾性分析。结果多因素分析发现以下独立的死亡危险因素：美国癌症联合委员会第8版病理分期(P)N2期与pN0期(风险比[HR]，5.5；P=0.000006)，大体淋巴结转移(ENE)与非ENE(HR，4.90；P&lt；0.02)，淋巴结阳性(LN)百分比=10%(HR，4.2；P=0.0002)，以及5个或5个以上LN阳性(HR，4.9；P=0.00004)。AJCC第8版pN2vspN0的三年OS明显更差，但第7版pn2vspN0病的三年OS没有明显恶化。手术切缘阳性与阴性、AJCC第8版II期与I期、病理或肉眼观察ENE与非ENE阳性淋巴结相比，5年的OS明显更差。523例(71%)AJCC第8版I期患者和283例(38%)PT1~T2切缘阴性、行颈清扫术切除20枚淋巴结的患者，3年OS率分别为93%和95%，5年OS率分别为91%和95%。结论在NCDB缺乏细节和可能存在不准确的情况下，AJCC第8版HPV+OPSCC单独手术治疗，特别是PT1-T2，pN0-N1

Objective Survival outcomes for human papillomavirus-associated oropharynx squamous cell carcinoma (HPV + OPSCC) treated with surgery alone are unclear. To increase understanding, we assessed overall survival (OS) outcomes using the national cancer database (NCDB). Methods We conducted a retrospective analysis of OS of 736 NCDB HPV + OPSCC patients who underwent surgery alone from 2010 to 2014 using univariate and multivariate analyses and the Kaplan-Meir method. Results Multivariable analysis found the following independent risk factors for death: American Joint Commission on Cancer (AJCC) 8th edition pathologic stage(p)N2 versus pN0 disease (hazard ratio [HR], 5.5; P = 0.000006), macroscopic extranodal extension (ENE) versus non-ENE (HR, 4.9; P < 0.02), a positive lymph nodes (LN) percentage of >= 10% (HR, 4.2; P = 0.0002), and five or more positive LNs (HR, 4.9; P = 0.00004). Three-year OS was significantly worse for AJCC 8th edition pN2 versus pN0 but not for 7th edition pN2 versus pN0 disease. Five-year OS was significantly worse for positive versus negative surgical margins, AJCC 8th edition stage II versus I, and either microscopic or macroscopic ENE versus non-ENE positive LNs. For 523 (71%) AJCC 8th edition stage I patients and for 283 (38%) patients who were pT1-T2, with negative margins, pN0-N1, with 20 LNs removed during neck dissection, the 3-year OS rates were 93% and 95%, respectively, and the 5-year OS rates were 91% and 95%, respectively. Conclusion In the context of the lack of detail and possible inaccuracies found in the NCDB, surgery alone for AJCC 8th edition stage I HPV + OPSCC, particularly pT1-T2, pN0-N1 with

Predictors of Mortality in HPV-Associated Oropharynx Carcinoma Treated With Surgery Alone

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