Long-term survival after distant metastasis in patients with oropharyngeal cancer
Long-term survival after distant metastasis in patients with oropharyngeal cancer
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DOI：
10.1016/j.oraloncology.2013.10.020
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发表时间：
2014-03-01
期刊：
影响因子：
4.8
通讯作者：
Chan, Annie W.
中科院分区：
文献类型：
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作者：
McBride, Sean M.;Busse, Paul M.;Chan, Annie W.
目的：对于口咽鳞状细胞癌(OPSCC)患者，尤其是HPV阳性的患者，局部区域控制是很好的。然而，远处转移仍然是一个实质性的问题。我们研究的目的是评估OPSCC患者远处转移后的预后和生存预测因素。材料和方法：在2002年6月至2011年1月期间，25例OPSCC患者在有治疗意图的情况下随后发生了远处转移。评估的主要终点是到远处转移的时间和发生远处转移后的总体生存期。采用中位数回归分析或COX回归对预后预测因素进行评估。选择最佳子集模型来最小化贝叶斯信息准则(BIC)。根据所选择的模型建立远端失败后生存的预后指数。结果：放疗完成后的中位远处转移时间为7.9个月(范围为1.6-25.4)。远处转移的中位总生存期为18.3个月(95%CI，14.3~39.8)。发生远处转移后1年和2年的总生存率分别为72.0%(95%可信区间53.4~89.6)和40.8%(95%可信区间20.6~61.0)。在多变量分析中，卡诺夫斯基功能状态评分=80(P=0.0 1，危险比0.15，95%可信区间0.0 4~0.5 2)和局限性、单器官疾病(P=0.003，HR 0.13，95%可信区间0.0 3~0.6 1)预测远处转移的生存率增加。疾病有限且KPS良好的患者构成了最有利的风险组，2年生存率为100%。2例人乳头瘤病毒(HPV)阳性肿瘤患者在接受局部侵袭性治疗后，分别在64.6个月和60.4个月无任何疾病存活。结论：局限性、单器官病变、KPS良好的OPSCC患者可获得长期生存。(C)爱思唯尔有限公司出版的2013年。
Objectives: For patients with oropharyngeal squamous cell carcinoma (OPSCC), especially for those with HPV-positive tumors, locoregional control is excellent. Distant metastasis, however, remains a substantial problem. The purpose of our study was to evaluate outcomes and predictors of survival after distant metastasis in OPSCC.Materials and methods: Between June 2002 and January 2011, 25 OPSCC patients treated with curative intent subsequently developed distant metastasis. The primary end-points evaluated were time-to-distant metastasis and overall survival after development of distant metastasis. Predictors of outcome were evaluated with median regression analysis or Cox regression. Best subset models were chosen to minimize the Bayesian Information Criterion (BIC). A prognostic index for survival after distant failure was created based on the selected model.Results: Median time-to-distant metastasis after completion of radiation was 7.9 months (range, 1.6-25.4). Median overall survival from distant metastasis was 18.3 months (95% CI, 14.3-39.8). The overall survival rates at 1-and 2-year after development of distant metastasis were 72.0% (95% confidence interval [CI], 53.4-89.6) and 40.8% (95% CI, 20.6-61.0), respectively. In multivariate analysis, Karnofsky Performance Status score (KPS) >= 80 (p = 0.01, hazard ratio [HR] 0.15, 95% CI, 0.04-0.52) and limited, single-organ disease (p = 0.003, HR 0.13, 95% CI 0.03-0.61) predicted for increased survival from distant metastasis. Patients with both limited disease and good KPS formed the most favorable risk group with a 2-year survival of 100%. Two patients with human papilloma virus (HPV)-positive tumors were alive without any evidence of disease at 64.6 and 60.4 months, respectively, after aggressive local treatment of solitary metastasis.Conclusion: For OPSCC patients with limited, single-organ disease and good KPS, long-term survival can be achieved. (C) 2013 Published by Elsevier Ltd.