Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study
Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study
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DOI：
10.1016/s1470-2045(15)00560-4
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发表时间：
2016-04-01
期刊：
影响因子：
51.1
通讯作者：
Xu, Wei
中科院分区：
文献类型：
--
作者：
O'Sullivan, Brian;Huang, Shao Hui;Xu, Wei
背景 人乳头瘤病毒相关（HPV+）口咽癌是一种迅速出现的疾病，通常预后良好。许多口咽癌的预后算法将 HPV 状态作为分层因素，而不是认识到 HPV+ 疾病的独特性。口咽癌分期国际合作网络 (ICON-S) 旨在开发针对 HPV+ 口咽癌的 TNM 分类。 方法 ICON-S 研究纳入了来自欧洲和北美七个癌症中心的非转移性口咽癌患者；一个中心组成训练队列，六个中心组成验证队列。我们通过 p16 染色或原位杂交确定了患者的 HPV 状态。我们根据第 7 版 TNM 分类和 HPV 状态比较了训练组和验证组之间的 5 年总生存率。我们使用递归分区分析 (RPA) 和调整风险比 (AHR) 建模方法来得出 HPV+ 口咽癌的新分期分类。最近还在探索性训练队列中研究了有关下颈部淋巴结和淋巴结数量的影响的假设，以评估 ICON-S 分类中的相关性。结果 在 1907 名 HPV+ 口咽癌患者中，培训中心招募了 661 名 (35%) 患者，验证中心招募了 1246 名 (65%) 名患者。第 7 版 TNM I、II、III 和 IVA 期的 5 年总体生存率相似（分别为 88% [95% CI 74-100]、82% [71-95]、84% [79-89] 和 81% [79-83]；总体 p=0.25），但 IVB 期较低（60% [53-68]；p
Background Human papillomavirus-related (HPV+) oropharyngeal cancer is a rapidly emerging disease with generally good prognosis. Many prognostic algorithms for oropharyngeal cancer incorporate HPV status as a stratification factor, rather than recognising the uniqueness of HPV+ disease. The International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) aimed to develop a TNM classification specific to HPV+ oropharyngeal cancer.Methods The ICON-S study included patients with non-metastatic oropharyngeal cancer from seven cancer centres located across Europe and North America; one centre comprised the training cohort and six formed the validation cohorts. We ascertained patients' HPV status with p16 staining or in-situ hybridisation. We compared overall survival at 5 years between training and validation cohorts according to 7th edition TNM classifications and HPV status. We used recursive partitioning analysis (RPA) and adjusted hazard ratio (AHR) modelling methods to derive new staging classifications for HPV+ oropharyngeal cancer. Recent hypotheses concerning the effect of lower neck lymph nodes and number of lymph nodes were also investigated in an exploratory training cohort to assess relevance within the ICON-S classification.Findings Of 1907 patients with HPV+ oropharyngeal cancer, 661 (35%) were recruited at the training centre and 1246 (65%) were enrolled at the validation centres. 5-year overall survival was similar for 7th edition TNM stage I, II, III, and IVA (respectively; 88% [95% CI 74-100]; 82% [71-95]; 84% [79-89]; and 81% [79-83]; global p=0.25) but was lower for stage IVB (60% [53-68]; p