头颈部转移性皮肤鳞状细胞癌：免疫抑制、治疗、结外扩散及切缘状态（ITEM）预后评分用于预测预后及改善生存的必要性。

Metastatic cutaneous squamous cell carcinoma of the head and neck: the Immunosuppression, Treatment, Extranodal spread, and Margin status (ITEM) prognostic score to predict outcome and the need to improve survival.

作者信息

Oddone Nicolas, Morgan Gary J, Palme Carsten E, Perera Lakmalie, Shannon Jennifer, Wong Eva, Gebski Val, Veness Michael J

机构信息

Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia.

出版信息

Cancer. 2009 May 1;115(9):1883-91. doi: 10.1002/cncr.24208.

DOI:10.1002/cncr.24208

PMID:19224549

Abstract

BACKGROUND

: The authors propose a prognostic score model using a prospective study of patients with regional metastatic cutaneous squamous cell carcinoma of the head and neck.

METHODS

: Two-hundred fifty patients were analyzed using a competing risks model to identify risk factors for survival. A risk score was obtained using the significant coefficients from the regression model, and cutoff points were determined that separated the score into 3 risk groups (low risk, moderate risk, and high risk).

RESULTS

: At a median follow-up of 54 months (range, 1.3-212 months) 70 of 250 patients (28%) developed recurrent disease: Most were regional recurrences (51 of 70 patients; 73%) in the treated lymph node basin. After regional recurrence, a majority (73%) died of disease. The following 4 variables were associated significantly with survival: immunosuppression (hazard ratio [HR], 3.13; 95% confidence interval [CI], 1.39-7.05), treatment (HR, 0.32; 95% CI, 0.16-0.66), extranodal spread (HR, 9.92; 95% CI, 1.28-77.09), and margin status (HR, 1.85; 95% CI, 1.85-3.369); and those 4 variables (immuosuppression, treatment, extranodal spread, and margin status) were used to calculate the ITEM score. The 5-year risk of dying from disease for patients with high-risk (>3.0), moderate-risk (>2.6-3.0), and low-risk (< or =2.6) ITEM scores were 56%, 24%, and 6%, respectively. Fifty-six of 250 patients (22%) died from another cause.

CONCLUSIONS

: Patients who underwent surgery and received adjuvant radiotherapy had a better outcome compared with patients who underwent surgery alone. Patients who had moderate- or high-risk ITEM scores, usually because of extranodal spread and involved excision margins, had a poor outcome. The authors recommend considering these patients for inclusion in adjuvant chemoradiotherapy trials. Cancer 2009. (c) 2009 American Cancer Society.

摘要

背景

作者通过对头颈部局部转移性皮肤鳞状细胞癌患者的前瞻性研究，提出了一种预后评分模型。

方法

采用竞争风险模型对250例患者进行分析，以确定生存的危险因素。利用回归模型中的显著系数获得风险评分，并确定将评分分为3个风险组（低风险、中度风险和高风险）的临界点。

结果

在中位随访54个月（范围1.3 - 212个月）时，250例患者中有70例（28%）出现疾病复发：大多数为局部复发（70例患者中的51例；73%），发生在治疗的淋巴结区域。局部复发后，大多数患者（73%）死于疾病。以下4个变量与生存显著相关：免疫抑制（风险比[HR]，3.13；95%置信区间[CI]，1.39 - 7.05）、治疗方式（HR，0.32；95% CI，0.16 - 0.66）、结外扩散（HR，9.92；95% CI，1.28 - 77.09）和切缘状态（HR，1.85；95% CI，1.85 - 3.369）；这4个变量（免疫抑制、治疗方式、结外扩散和切缘状态）用于计算ITEM评分。ITEM评分高风险（>3.0）、中度风险（>2.6 - 3.0）和低风险（≤2.6）患者的5年疾病死亡风险分别为56%、24%和6%。250例患者中有56例（22%）死于其他原因。