Predictors of locoregional recurrence in early stage oral cavity cancer with free surgical margins
Predictors of locoregional recurrence in early stage oral cavity cancer with free surgical margins
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DOI：
10.1016/j.oraloncology.2009.10.011
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发表时间：
2010-01-01
期刊：
影响因子：
4.8
通讯作者：
Chen, Peir-Rong
中科院分区：
文献类型：
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作者：
Huang, Tsai-Ying;Hsu, Lee-Ping;Chen, Peir-Rong
早期口腔鳞状细胞癌（ESOSCC）患者手术后局部复发仍然是一个问题，并可能影响其生存。我们回顾性分析了2002年至2006年间148例手术切缘阴性的食管鳞状细胞癌患者的资料。主要终点是局部复发。采用Kaplan-Meier法计算无复发生存期（RFS）和总生存期（OS）。单变量和多变量分析用于确定局部复发的独立预测因子。根据预测因子的优势比（OR）将所有患者分为低风险组和高风险组。然后预测低风险组和高风险组的复发率，在本研究结束时，148例患者中有17例（11.5%）复发。所有患者均未接受术后放疗或化疗。3年时，RFS率为89.7%，3年OS率为84.1%。RFS的单变量分析揭示了三个显著的预后因素：淋巴血管渗透（LVP，p < 0.001）、神经周围浸润（PNI，p = 0.08）和非T4肌浸润（非T4 MI，p < 0.005）。多变量分析表明，LVP（p = 0.007，OR = 10.7）和非T4 MI（p = 0.001，OR = 8.347）是独立预测因素。无LVP或非T4 MI患者的复发率为1.96%，非T4 MI患者的复发率增加至26.47%，LVP患者的复发率增加至50%，两者均存在的患者的复发率增加至50%。根据LVP和非T4 MI的状态，将患者分为两组：低风险组（不存在任何因素）和高风险组（存在一种或两种因素）。高风险组的2年RFS（84.13%）低于低风险组（93.91%）;高风险组的3年RFS（70.49%）也低于低风险组（91.99%）（p = 0.008）。亚组分析显示，选择性颈清扫术不影响结局或改变失败模式。对于选择性颈清扫术的患者，高风险组的RFS低于低风险组（p = 0.03）。在ESOSCC（pT 1 - 2N 0）中，LVP和非T4 MI显著增加复发率。一种或两种因素（LVP和/或非T4 MI）的存在应被视为局部复发的高风险状况，在这种情况下需要辅助治疗。(C)2009爱思唯尔有限公司保留所有权利。
Locoregional recurrence in patients with early stage oral cavity squamous cell carcinoma (ESOSCC) after surgery remains a problem and can affect their survival. We sought to identify new high-risk factors in these patients, who need further adjuvant therapy.We retrospectively reviewed records for 148 patients who underwent surgery for ESOSCC between 2002 and 2006 with negative surgical margins. The primary endpoint was locoregional recurrence. Recurrence-free survival (RFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence. All patients were grouped into the low-and high-risk groups according to the odds ratios (OR) of the predictors. Recurrence rates of the low-and high-risk groups were then predicted.Recurrence was observed in 17 of 148 (11.5%) patients at the end of this study. None of the patients received postoperative radiotherapy or chemotherapy. At 3 years, the RFS rate was 89.7% and the OS rate at 3 years was 84.1%. Univariate analysis of the RFS revealed three significant prognostic factors: lymphovascular permeation (LVP, p < 0.001), perineural infiltration (PNI, p = 0.08), and non-T4 muscular invasion (non-T4MI, p < 0.005). Multivariate analysis demonstrated that LVP (p = 0.007, OR = 10.7) and non-T4 MI (p = 0.001, OR = 8.347) were independent predictors. The recurrence rate was 1.96% in patients without LVP or non-T4MI, and it increased to 26.47% in patients with non-T4MI, to 50% in patients with LVP, and to 50% in patients with both. According to the status of LVP and non-T4MI, patients were divided into two groups: low-risk (no factors present) and high-risk (one or both factors present) groups. The 2-year RFS was lower in the high-risk group (84.13%) than in the low-risk group (93.91%); the 3-year RFS was also lower in the high-risk group (70.49%) than in the low-risk group (91.99%) (p = 0.008). Subgroup analysis revealed that elective neck dissections did not affect the outcome or change the pattern of failure. For patients with elective neck dissections, the RFS was lower in the high-risk group than in the low-risk group (p = 0.03).In ESOSCC (pT1-2N0), LVP and non-T4MI significantly increased the recurrence rate. The presence of one or both factors (LVP and/or non-T4MI) should be considered as a high-risk condition for locoregional recurrence, and adjuvant therapy is needed in such cases. (C) 2009 Elsevier Ltd. All rights reserved.