Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma
Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma
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DOI：
10.1002/cncr.26671
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发表时间：
2012-07-15
期刊：
影响因子：
6.2
通讯作者：
Haughey, Bruce H.
中科院分区：
文献类型：
--
作者：
Sinha, Parul;Lewis, James S., Jr.;Haughey, Bruce H.
背景：囊外扩散（ECS）通常用于证明头颈癌患者辅助化疗的合理性。然而，ECS在手术切除的人乳头瘤病毒相关口咽鳞状细胞癌（OPSCC）中作为辅助治疗决定因素的作用尚未确定。方法：采用正交设计法在前瞻性经口激光显微手术数据库中的210例口咽部患者中，152例p16阳性原发性OPSCC和病理阳性颈部患者符合研究条件。通过常规报告（ECS报告）和使用新型组织学分级系统（ECS分级）测量ECS。比例风险模型和匹配分析用于比较ECS和辅助治疗对无病生存期（DFS）的影响。分级ECS患者和未分级ECS患者的T分期、手术切缘和辅助治疗相匹配。研究结果：在中位随访43个月时，多变量分析显示，ECS的存在与DFS较差无关（ECS报告：风险比[HR]，3.42; 95%置信区间[CI]，0.45-25.88; P = 0.23; ECS分级：HR，2.54; 95% CI，0.88-7.34; P = 0.09）。T分期和高级别ECS即软组织转移（STM分级）是预后因素。总体而言，在存在ECS甚至STM的情况下，辅助CRT与单独放疗的DFS无关（HR，0.25; 95% CI，0.06-1.13; P = 0.07）。此外，匹配分析表明，在ECS阳性患者中，存在ECS与不存在ECS相比，DFS没有显著降低，或者单独辅助放疗与CRT相比，DFS降低。结论：在本研究中，既往报道的ECS无预后。对于ECS阳性患者，辅助CRT与单独放疗相比，DFS没有改善。作者建议，对于接受手术的p16阳性OPSCC患者，应考虑降级辅助治疗，并且常规报告的ECS不应用于证明辅助化疗的合理性。癌症2012;35193530。(C)2011年美国癌症协会
BACKGROUND: Extracapsular spread (ECS) is commonly used to justify adjuvant chemotherapy in patients with head and neck cancer. The role of ECS as a prognosticator and adjuvant therapy determinant in surgically resected, human papillomavirus-related oropharyngeal squamous cell carcinoma (OPSCC), however, has never been determined. METHODS: Of 210 oropharynx patients in a prospective transoral laser microsurgery database, 152 patients who had p16-positive primary OPSCC and pathologically positive necks were eligible for the study. ECS was measured from routine reporting (ECSreport) and by using a novel histologic grading system (ECSgraded). Proportional hazards models and matched analyses were used to compare the impact of ECS and adjuvant therapy on disease-free survival (DFS). Patients with and without graded ECS were matched for T-stage, surgical margins, and adjuvant therapy. RESULTS: At a median follow-up of 43 months, the presence of ECS was not associated with poorer DFS in multivariate analyses (ECSreport: hazard ratio [HR], 3.42; 95% confidence interval [CI], 0.45-25.88; P = .23; ECSgraded: HR, 2.54; 95% CI, 0.88-7.34; P = .09). T-stage and high-grade ECS, ie soft tissue metastasis (STMgraded) were prognostic. Overall and in the presence of ECS or even STM, adjuvant CRT was not associated with better DFS over radiotherapy alone (HR, 0.25; 95% CI, 0.06-1.13; P = .07). In addition, matched analyses demonstrated no significant reduction in DFS for the presence of ECS versus the absence of ECS or reduced DFS for the administration of adjuvant radiotherapy alone versus CRT in ECS-positive patients. CONCLUSIONS: Routinely reported ECS was not prognostic in this study. Adjuvant CRT versus radiotherapy alone produced no improvement in DFS for ECS-positive patients. The authors propose that de-escalated adjuvant therapy should be considered for patients with p16-positive OPSCC who undergo surgery and that routinely reported ECS should not be used to justify adjuvant chemotherapy. Cancer 2012;35193530. (C) 2011 American Cancer Society.