Characteristics and long-term outcomes of head and neck squamous cell carcinoma after solid organ transplantation
Characteristics and long-term outcomes of head and neck squamous cell carcinoma after solid organ transplantation
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DOI：
10.1016/j.oraloncology.2017.07.010
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发表时间：
2017-09-01
期刊：
影响因子：
4.8
通讯作者：
Okuno, Scott H.
中科院分区：
文献类型：
--
作者：
Alsidawi, Samer;Price, Katharine A.;Okuno, Scott H.
实体器官移植后的免疫抑制可防止移植排斥反应，但会导致包括头颈部鳞状细胞癌（HNSCC）在内的各种恶性肿瘤的发病率增加。移植后HNSCC患者的预后尚不清楚。材料和方法：我们回顾性分析了1995年至2010年间实体器官移植后发生HNSCC的患者。病理证实的成年HNSCC和充分的随访纳入。使用Kaplan-Meier方法分析中位总生存期和无进展生存期。采用Cox比例风险模型研究各变量的预后影响。结果：33例患者符合研究纳入标准。移植后确诊HNSCC的中位时间为5.9年。原发部位口腔15例，口咽10例，喉3例，下咽2例，腮腺2例，未知部位1例。88%的患者接受了前期手术切除。其中66%的患者接受了辅助治疗。6%的患者接受了明确的放化疗。治疗耐受性良好，没有导致移植排斥反应。局部和局部晚期疾病的5年总生存率分别为45%和37%。75%的口咽肿瘤患者是hpv阳性，他们有更好的结果（5年总生存率为67%）。在多变量分析中，年龄>= 60岁是生存率的负相关预测因子（HR 2.7; 95% CI, 1.1-6.5; P = 0.03）。结论：移植后HNSCC患者生存率相对较低，局部和远处复发的风险较高。hpv阳性口咽肿瘤在这一人群中仍有较好的预后。(c) 2017 Elsevier Ltd.版权所有。
Introduction: Immunosuppression after solid organ transplant prevents graft rejection, but leads to increased incidence of various malignancies including head and neck squamous cell carcinoma (HNSCC). Outcomes of patients with post-transplant HNSCC are unknown.Materials and methods: We retrospectively identified patients who developed HNSCC after solid organ transplant between 1995 and 2010. Adults with pathology-proven HNSCC and adequate follow up were included. Median overall survival and progression free survival were analyzed using the Kaplan-Meier method. The prognostic effect of variables was studied with Cox proportional hazards models.Results: Thirty-three patients met study inclusion criteria. The median time to diagnosis of HNSCC after transplant was 5.9 years. The primary site was oral cavity in 15 patients, oropharynx in 10, larynx in 3, hypopharynx in 2, parotid in 2 and unknown in 1 patient. Eighty-eight percent underwent upfront surgical resection. Of those, sixty-six percent received adjuvant therapy. Six percent of patients had definitive chemoradiation. Treatment was well tolerated and did not lead to graft rejection. The 5-year overall survival rate was 45% and 37% for localized and locally advanced disease respectively. Seventy-five percent of patients with oropharyngeal tumors were HPV-positive and they had better outcomes (5-year overall survival rate of 67%). In multivariate analysis, age >= 60 years was a negative predictor of survival (HR 2.7; 95% CI, 1.1-6.5; P = 0.03).Conclusions: Patients with post-transplant HNSCC have relatively poor survival and high risk of locoregional and distant recurrence. HPV-positive oropharyngeal tumors continue to have better outcomes in this population. (c) 2017 Elsevier Ltd. All rights reserved.