Refining the Role of Lymph Node Biopsy in Survival for Patients with Nasopharyngeal Carcinoma: Population-Based Study from the Surveillance Epidemiology and End-Results Registry
Refining the Role of Lymph Node Biopsy in Survival for Patients with Nasopharyngeal Carcinoma: Population-Based Study from the Surveillance Epidemiology and End-Results Registry
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完善淋巴结活检对鼻咽癌患者生存的作用：基于流行病学监测和最终结果登记的人群研究
DOI：
10.1245/s10434-017-5966-4
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发表时间：
2017-09-01
影响因子：
3.7
通讯作者：
Sun, Ying
中科院分区：
文献类型：
--
作者：
Lv, Jia-Wei;Zhou, Guan-Qun;Sun, Ying
背景美国国家综合癌症网络（NCCN）的最新版指南将鼻咽癌（NPC）的治疗前检查修改为“原发部位或颈部活检”。尽管提供了重要的诊断信息，但对肿瘤细胞播散的担忧限制了淋巴结活检的应用。本研究旨在调查颈部活检是否与NPC的生存率受损相关。从监测、流行病学和最终结果数据库中确定了一个倾向评分匹配的、基于人群的队列，用于比较接受预处理颈部淋巴结活检而未进行后续颈清扫或淋巴结切除的患者与未接受淋巴结活检的患者的总生存率（OS）和疾病特异性生存率（DSS）。在2910例合格患者中，416例（14.3%）接受了治疗前淋巴结活检。在对患者、肿瘤和人口统计学特征进行对照后，活检与OS受损（风险比[HR]，1.15; 95%置信区间[CI] 0.89-1.47; P = 0.29）或DSS受损（HR，1.07; 95% CI 0.81-1.40; P = 0.63）无关。有趣的是，在亚组分析中，在分化型非角化性鳞状细胞癌患者中观察到活检的不利影响（而不是其他组织学类型）。种族对生存结果没有积极影响。研究结果为临床实践提供了参考，表明除分化型非角化性鳞状细胞癌患者外，预处理颈淋巴结活检与NPC患者的生存率无关。推荐的NCCN指南将更加具体，增加了颈部活检对所有患者都是安全的一般建议的细节。未来的前瞻性研究需要验证研究结果。
Background. The updated version of the National Comprehensive Cancer Network (NCCN) guidelines revised pretreatment workup for nasopharyngeal carcinoma (NPC) into "biopsy of the primary site or neck." Despite provision of important diagnostic information, concerns regarding tumor cell dissemination limit the application of lymph node biopsy. This study aimed to investigate whether biopsy of the neck is associated with impaired survival in NPC.Methods. A propensity score-matched, population-based cohort identified from the Surveillance, Epidemiology, and End Results database was used to compare overall survival (OS) and disease-specific survival (DSS) of patients who underwent pretreatment cervical lymph node biopsy without subsequent neck dissection or removal of node compared with patients who did not undergo node biopsy.Results. Of 2910 eligible patients, 416 (14.3%) underwent pretreatment lymph node biopsy. After use of control for patient, tumor, and demographic characteristics, biopsy was not associated with impaired OS (hazard ratio [HR], 1.15; 95% confidence interval [CI] 0.89-1.47; P = 0.29) or DSS (HR, 1.07; 95% CI 0.81-1.40; P = 0.63). Interestingly, in the subgroup analysis, the unfavorable effect of biopsy was observed for patients with differentiated non-keratinizing squamous cell carcinoma (but not other histologic types). Race did not positively alter the survival outcomes.Conclusions. The findings provide reference for clinical practice, showing that pretreatment cervical lymph node biopsy is not associated with impaired survival in NPC, except for patients with differentiated non-keratinizing squamous cell carcinoma. The recommended NCCN guidelines would be more specific by adding details to the general recommendation that neck biopsy is safe for all patients. Future prospective studies are needed to verify the study findings.