Extent of Pathologic Extracapsular Extension and Outcomes in Patients With Nonoropharyngeal Head and Neck Cancer Treated With Initial Surgical Resection
Extent of Pathologic Extracapsular Extension and Outcomes in Patients With Nonoropharyngeal Head and Neck Cancer Treated With Initial Surgical Resection
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DOI：
10.1002/cncr.28596
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发表时间：
2014-05-15
期刊：
影响因子：
6.2
通讯作者：
Beitler, Jonathan J.
中科院分区：
文献类型：
--
作者：
Prabhu, Roshan S.;Hanasoge, Sheela;Beitler, Jonathan J.
背景：淋巴结囊外延伸（ECE）是头颈癌已知的不良预后因素，是辅助放化疗（CRT）的指征。然而，在辅助CRT的设置中，ECE的程度可能提供额外的预后信息。方法本研究纳入350例接受首次手术切除的口腔癌（72.6%）或大体积/非功能性喉癌（27.4%）患者。根据Lewis等建立的量表，ECE程度从0到4分。多变量分析（MVA）根据原发部位、病理危险因素和辅助治疗进行调整。结果在单因素无失败生存（FFS）分析中，淋巴结阳性疾病且无ECE（0级）患者的FFS与ECE 1至3级患者的FFS无显著差异。然而，ECE 4级患者的FFS明显较差。在FFS的MVA中，ECE 0至3级和4级之间的差异并不显著。在总生存的MVA中，ECE 4级与ECE 0级（风险比，0.46；P= 0.02）和ECE 1 ~ 3级（风险比，0.41；P= 0.01）相比，死亡风险更高。结论ECE的二分法评估有助于确定合适的辅助治疗，但在辅助CRT的设置中附加的预后价值有限。与无ECE相比，1至3级ECE的有害影响可以通过辅助CRT有效减轻，但4级ECE的预后较差，尽管CRT对总生存期有影响。ECE 4级患者可能是研究新辅助治疗强化方法的试验候选人。癌症2014;120:1499 - 1506。(c) 2014年美国癌症协会。淋巴结囊外延伸（ECE）的二分法评估（存在/不存在）对于确定适当的辅助治疗是有用的，但对于切除的头颈部癌的辅助放化疗（CRT）设置的附加预后价值有限。在总体生存方面，1 - 3级ECE相对于无ECE的不利影响可以通过辅助CRT有效缓解，但4级ECE尽管进行了CRT，但预后仍较差。
BACKGROUNDLymph node extracapsular extension (ECE) is a known adverse prognostic factor in head and neck cancer and is an indication for adjuvant chemoradiation (CRT). However, the extent of ECE may provide additional prognostic information in the setting of adjuvant CRT.METHODSThis study included 350 patients with oral cavity cancer (72.6%) or bulky/nonfunctional laryngeal cancer (27.4%) who underwent initial surgical resection. Extent of ECE was graded from 0 to 4 based on the scale established by Lewis and colleagues. Multivariable analyses (MVA) were adjusted for primary site, pathologic risk factors, and adjuvant therapy.RESULTSIn univariate failure-free survival (FFS) analysis, there was no significant difference in FFS for patients with lymph node-positive disease and no ECE (grade 0) versus patients with ECE grades 1 through 3. However, patients with ECE grade 4 had significantly worse FFS. In MVA for FFS, differences between ECE grades 0 through 3 and grade 4 did not remain significant. In MVA of overall survival, ECE grade 4 was significantly associated with higher risk of death compared with ECE grade 0 (hazard ratio, 0.46; P=.02) and ECE grades 1 through 3 (HR, 0.41; P=.01).CONCLUSIONSDichotomous evaluation of ECE is useful for determining appropriate adjuvant therapy but has limited additional prognostic value in the setting of adjuvant CRT. The detrimental effect of ECE grades 1 through 3 relative to no ECE is effectively mitigated with adjuvant CRT, but ECE grade 4 retains a poorer prognosis despite CRT with regard to overall survival. Patients with ECE grade 4 may be candidates for trials investigating novel methods of adjuvant therapy intensification. Cancer 2014;120:1499-1506. (c) 2014 American Cancer Society.Dichotomous evaluation (present/absent) of lymph node extracapsular extension (ECE) is useful for determining appropriate adjuvant therapy but has limited additional prognostic value in the setting of adjuvant chemoradiation (CRT) for resected head and neck cancer. With regard to overall survival, the detrimental effect of ECE grades 1 through 3 relative to no ECE is effectively mitigated with adjuvant CRT, but ECE grade 4 retains a poorer prognosis despite CRT.