Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma
Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma
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DOI：
10.1007/s12105-012-0412-1
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发表时间：
2013-09-01
影响因子：
2.1
通讯作者：
Brandwein-Gensler, Margaret
中科院分区：
文献类型：
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作者：
Li, Yufeng;Bai, Shuting;Brandwein-Gensler, Margaret
风险模型是头颈部鳞状细胞癌患者的有效预后预测因子（Brandwein-Gensler et al. in AmJ外科病理学杂志20:167 -178,2005；AmJ外科病理学杂志20:676 -688,2010）。这种模式可能会改变低阶段癌症患者的治疗模式，因为目前的方案规定他们可能只接受初级手术。在这里，我们检验了风险模型对低阶段口腔鳞状细胞癌（OCSCC）患者的预后有增加价值的假设。根据风险模型对299例I/II期OCSCC患者进行了特征分析（Brandwein-Gensler et al. in AmJ外科病理学杂志20:167 -178,2005；AmJ外科病理学杂志20:676 -688,2010）。对局部复发（LRR）和疾病特异性生存（DSS）进行累积发生率和竞争风险分析。对最坏侵袭模式（WPOI）和风险类别进行受试者操作特征分析。分析292例患者；T1N0患者30例（17%），T2N0患者26例（23%）发生LRR。9例T1N0患者（6%）和9例T1N0患者（10%）出现疾病特异性死亡率。在多变量分析中，风险模型对潜在混杂因素校正后的LRR （p = 0.0012, HR 2.41, 95% CI 1.42, 4.11）和DSS （p = 0.0005, HR 9.16, 95% CI 2.65, 31.66）具有显著的预测作用。单独WPOI对潜在混杂因素调整后的LRR也具有显著的预测作用，其临界值为WPOI-4 （p = 0.0029, HR 3.63, 95% CI 1.56, 8.47）或WPOI-5 （p = 0.0008, HR 2.55, 95% CI 1.48, 4.41）和DSS（临界值WPOI-5， p = 0.0001, HR 6.34, 95% CI 2.50, 16.09）。在WPOI5的情况下，局部复发的概率为42%。考虑到除WPOI-5外的其他特征的高风险分类，局部复发的概率为32%。风险模型是第一个被验证的模型，可以显著预测低阶段OCSCC患者的重要利基群体。
The Risk Model is a validated outcome predictor for patients with head and neck squamous cell carcinoma ( Brandwein-Gensler et al. in Am J Surg Pathol 20: 167-178, 2005; AmJ Surg Pathol 34: 676-688, 2010). This model may potentially shift treatment paradigms for patients with low-stage cancers, as current protocols dictate that they might receive only primary surgery. Here we test the hypothesis that the Risk Model has added prognostic value for low-stage oral cavity squamous cell carcinoma (OCSCC) patients. 299 patients with Stage I/II OCSCC were characterized according to the Risk Model (Brandwein-Gensler et al. in AmJ Surg Pathol 20: 167-178, 2005; Am J Surg Pathol 34: 676-688, 2010). Cumulative incidence and competing risk analysis were performed for locoregional recurrence (LRR) and disease-specific survival (DSS). Receiver operating characteristic analyses were performed for worst pattern of invasion (WPOI) and the risk categories. 292 patients were analyzed; 30 T1N0 patients (17 %) and 26 T2N0 patients (23 %) developed LRR. Disease-specific mortality occurred in 9 T1N0 patients (6 %) and 9 T2N0 patients (10 %). On multivariable analysis, the Risk Model was significantly predictive of LRR (p = 0.0012, HR 2.41, 95 % CI 1.42, 4.11) and DSS (p = 0.0005, HR 9.16, 95 % CI 2.65, 31.66) adjusted for potential confounders. WPOI alone was also significantly predictive for LRR adjusted for potential confounders with a cut-point of eitherWPOI-4 (p = 0.0029, HR 3.63, 95 % CI 1.56, 8.47) or WPOI-5 (p = 0.0008, HR 2.55, 95 % CI 1.48, 4.41) and for DSS (cut point WPOI-5, p = 0.0001, HR 6.34, 95 % CI 2.50, 16.09). Given a WPOI5, the probability of developing locoregional recurrence is 42 %. Given a high-risk classification for a combination of features other than WPOI-5, the probability of developing locoregional recurrence is 32 %. The Risk Model is the first validated model that is significantly predictive for the important niche group of low-stage OCSCC patients.