Long-term survival in patients with metastatic head and neck squamous cell carcinoma treated with metastasis-directed therapy
Long-term survival in patients with metastatic head and neck squamous cell carcinoma treated with metastasis-directed therapy
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DOI：
10.1038/s41416-019-0601-8
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发表时间：
2019-11-26
影响因子：
8.8
通讯作者：
Tsai, C. Jillian
中科院分区：
文献类型：
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作者：
Beckham, Thomas H.;Leeman, Jonathan E.;Tsai, C. Jillian
背景：我们的目的是根据疾病负担评估转移性头颈鳞状细胞癌 (HNSCC) 的结果，重点是转移性疾病负担有限的患者的转移定向治疗 (MDT)。 方法：总共纳入了 186 名在 HNSCC 根治性治疗后出现转移性疾病的患者。列举了临床和放射学上明显的转移。 Kaplan-Meier 方法用于估计生存率。 Cox 回归用于评估临床变量之间的关联。 结果：单转移患者的 5 年总生存 (OS) 为 35% (95% CI 16-54%)，而多转移患者的 5 年总生存 (OS) 为 4% (95% CI 2-9%)。 30 名患者（16.1%）接受了 MDT。在多变量分析中，口腔或鼻窦原发性（分别为 HR 2.22，95% CI 1.16-4.25，p = 0.015；HR 4.88，95% CI 1.10-21.70，p = 0.037）与较高的死亡风险相关，而接受 MDT（HR 0.36，95% CI） 0.17-0.74，p = 0.006）与较低的死亡风险相关。 MDT 后的中位无转移生存期和 5 年生存期 (n = 30) 估计分别为 26.4 个月 (95% CI: 9.8-54.0) 和 31% (95% CI: 15-48%)。 结论：转移性疾病有限的 HNSCC 患者可能会从 MDT 中获得显着获益。评估 MDT 在 HNSCC 中的前瞻性试验是必要的。
BACKGROUND: Our objective was to evaluate the outcomes of metastatic head and neck squamous cell carcinoma (HNSCC) by disease burden with an emphasis on metastasis-directed therapy (MDT) in patients with limited metastatic disease burden.METHODS: In total, 186 patients who developed metastatic disease after definitive therapy for HNSCC were included. Clinically and radiographically apparent metastases were enumerated. Kaplan-Meier methods were used to estimate survival. Cox regression was used to assess the association between clinical variables.RESULTS: Patients with a single metastasis had a 5-year overall survival (OS) of 35% (95% CI 16-54%) in contrast to patients with multiple metastases with a 5-year OS of 4% (95% CI 2-9%). Thirty patients (16.1%) underwent MDT. On multivariable analysis, oral cavity or sinonasal primary (HR 2.22 95% CI 1.16-4.25, p = 0.015; HR 4.88, 95% CI 1.10-21.70, p = 0.037, respectively) were associated with higher risk of death, whereas receipt of MDT (HR 0.36, 95% CI 0.17-0.74, p = 0.006) was associated with lower hazard of death. Median subsequent metastasis-free survival and 5-year survival after MDT (n = 30) were estimated at 26.4 months (95% CI: 9.8-54.0) and 31%, (95% CI: 15-48%).CONCLUSIONS: HNSCC patients with limited metastatic disease may derive significant benefit from MDT. Prospective trials evaluating MDT in HNSCC are warranted.