Identification of High-Risk Subgroups of Patients With Oral Cavity Cancer in Need of Postoperative Adjuvant Radiotherapy or Chemo-Radiotherapy
Identification of High-Risk Subgroups of Patients With Oral Cavity Cancer in Need of Postoperative Adjuvant Radiotherapy or Chemo-Radiotherapy
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DOI：
10.1097/md.0000000000003770
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发表时间：
2016-05-01
期刊：
影响因子：
1.6
通讯作者：
Chen, Miao-Fen
中科院分区：
文献类型：
--
作者：
Chen, Wen-Cheng;Lai, Chia-Hsuan;Chen, Miao-Fen
口腔鳞状细胞癌（OSCC）手术患者如果存在不利的预后因素，建议接受辅助放疗联合或不联合化疗。淋巴结的切缘阳性（PRM）和包膜外淋巴结转移（ECE）是众所周知的主要预后因素。然而，对于口腔癌患者是否应该接受术后放化疗（CCRT），如果他们存在其他风险因素或2个或更多风险因素的组合，则没有达成一致意见。本研究对这一问题进行了调查，并提出了辅助治疗的建议。回顾性分析了2002年1月至2013年12月期间567例接受根治性手术的OSCC患者。分析5年局部区域控制（LRC）、无远处转移（DMF）、无病生存（DFS）和总生存（OS）。单因素分析中，病理T分类、阳性淋巴结、肿瘤深度、ECE、淋巴管或血管或神经周浸润和组织学分级是LRC、DMF、DFS或OS的显著预后因素。多因素分析中，病理T4（pT 4）、淋巴结转移、手术切缘阳性是LRC的预后因素。pT 4、阳性淋巴结和淋巴管浸润预示远处转移率较高。pT 4、淋巴结转移、低分化肿瘤是DFS的预后因素。pT 4、阳性淋巴结和ECE是OS的预后因素。这些因素用于确定风险组。我们提出PRM和ECE是主要的危险因素，pT 4、阳性淋巴结、闭合边缘（1 mm）、肿瘤深度>= 1 cm、淋巴管浸润、血管浸润、神经周围浸润和分化差是次要的危险因素。通过亚组分析，与仅手术组相比，至少有2个次要预后因素且无其他主要风险因素、术后放疗（RT）或CCRT的192例患者的5年LRC、DFS和OS显著更好。对于179例具有至少3个次要预后因素和/或至少1个主要风险因素的患者，与术后RT或单纯手术相比，接受术后CCRT的患者显示出显著更好的5年LRC、DFS和OS。具有2个次要风险因素的患者应接受术后RT。对于PRM、ECE或> 2个次要风险因素的患者，建议术后CCRT。
Patients with oral cavity squamous cell carcinoma (OSCC) undergoing surgery are recommended to receive adjuvant radiation therapy with or without chemotherapy if there are unfavorable prognostic factors. A positive resection margin (PRM) and extra-capsular extension (ECE) of lymph nodes are well-known major prognostic factors. However, there is no agreement on whether oral cavity cancer patients should receive postoperative chemo-radiotherapy (CCRT) if they present with other risk factors or a combination of 2 or more risk factors. In this study, we investigated this issue and provide suggestions for adjuvant treatments.From January 2002 to December 2013, 567 OSCC patients who had undergone radical surgery were retrospectively reviewed. The 5-year loco-regional control (LRC), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) were analyzed.In univariate analysis, pathological T classification, positive node, tumor depth, ECE, lymphatic or vascular or perineural invasion and histology grade are significant prognostic factors for LRC, DMF, DFS, or OS. By multivariate analysis, pathological T4 (pT4), positive node, positive surgical margin are prognostic factors for LRC. pT4, positive node and lymphatic invasion predicted for higher rate of distant metastasis. pT4, positive node, and poor differentiation tumor were prognostic factors for DFS. pT4, positive nodes, and ECE were prognostic factors for OS. These factors were used to define risk groups. We proposed PRM and ECE as major risk factors and pT4, positive nodes, close margin (1 mm), tumor depth >= 1 cm, lymphatic invasion, vascular invasion, perineural invasion, and poor differentiation as minor risk factors. By subgroups analysis, 192 patients with at least 2 minor prognostic factors and no other major risk factors, postoperative radiotherapy (RT), or CCRT yielded significantly better 5-year LRC, DFS, and OS compared to surgery only group. For 179 patients with at least 3 minor prognostic factors and/or at least 1 major risk factor, patients receiving postoperative CCRT showed significantly better 5-year LRC, DFS, and OS compared with post-OP RT or surgery alone.Patients with 2 minor risk factors should receive postoperative RT. For patients with PRM, ECE, or > 2 minor risk factors, postoperative CCRT is recommended.