Evaluation of pathologic staging using number of nodes in p16-negative head and neck cancer.
Evaluation of pathologic staging using number of nodes in p16-negative head and neck cancer.
复制标题
使用 p16 阴性头颈癌的淋巴结数量评估病理分期。
DOI：
10.1016/j.oraloncology.2020.104800
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发表时间：
2020
期刊：
影响因子：
4.8
通讯作者：
Hackman,TrevorG
中科院分区：
文献类型：
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作者：
Farquhar,DouglasR;Coniglio,AndrewJ;Masood,MaheerM;Lenze,Nicholas;Brennan,Paul;Anantharaman,Devasena;Abedi-Ardekani,Behnoush;Zanation,AdamM;Weissler,MarkC;Olshan,AndrewF;Sheth,Siddharth;Hackman,TrevorG
目的AJCC第8版头颈部鳞状细胞癌（HNSCC）分期指南最近介绍了p16阳性患者淋巴结疾病的病理分期标准。在这项研究中，我们评估p16阴性HNSCC的病理分期。材料和方法我们使用基于全州人口的队列比较了病理分期与第七版和第八版AJCC分期系统。所有M0 p16阴性手术患者均纳入。结果是5年总生存率。结果304例患者中，阴性113例，1-4淋巴结157例，≥4淋巴结34例。无淋巴结生存率为71% (95% CI 61-78%)， 1-4淋巴结生存率为48% (36% - 60%)，bb0 - 4淋巴结生存率为24%（11 - 39%）。与AJCC系统相比，病理分期产生了更大的总生存梯度，更单一的生存，更好的原发部位一致性，以及略低的贝叶斯信息标准（1510 vs 1538）。在调整疾病特征、人口统计学和烟草使用后，使用病理学和AJCC标准的生存风险比相似。结论在该队列中，病理分期比AJCC分期更具有预后价值。这是第一个评估p16阴性癌症病理分期的研究；如果这些发现得到证实，可以引入一个通用的淋巴结分期系统。
ObjectivesThe 8th edition AJCC staging guidelines for head and neck squamous cell carcinoma (HNSCC) recently introduced pathologic staging criteria for nodal disease among p16-positive patients. In this study we evaluate pathologic staging in p16-negative HNSCC.Materials and MethodsWe compared pathologic staging to the 7th and 8th edition AJCC staging systems using a statewide population-based cohort. All M0 p16-negative surgical patients were included. The outcome was five-year overall survival.ResultsOf 304 patients identified, 113 were N0, 157 had 1–4 positive nodes, and 34 had ≥4 nodes. Survival was 71% (95% CI 61–78%) with no nodes, 48% (36%−60%) for 1–4 nodes, and 24% (11 – 39%) for > 4 nodes. When compared to the AJCC systems, the pathologic staging yielded a larger total survival gradient, more montonic survival, better consistency across primary sites, and a slightly lower Bayesian information criterion (1510 vs 1538). After adjusting for disease characteristics, demographics, and tobacco use, hazard ratios for survival were similar using pathologic and AJCC criteria.ConclusionIn this cohort, pathological staging was more prognostic than AJCC staging. This is the first study to evaluate pathologic staging in p16-negative cancer; if these findings are verified, a universal nodal staging system could be introduced.