Departments of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
Head Neck. 2012 Dec;34(12):1727-33. doi: 10.1002/hed.21997. Epub 2012 Jan 13.
Despite better prognosis, there is a group of oropharyngeal squamous cell carcinoma (SCC) human papillomavirus (HPV)+ patients who experience treatment failure and succumb to distant metastasis.
Seventy-eight previously untreated patients nested in a concurrent chemoradiation protocol were reviewed to correlate patterns of local-regional tumor extent to distant metastasis. Biomarker assessment was: HPV in situ hybridization and epidermal growth factor receptor (EGFR) immunointensity.
The 3-year disease-specific survival (DSS) for patients presenting with and without matted nodes was 69% and 94%, respectively (p = .003). Matted nodes were a poor prognostic factor independent of T classification, HPV, EGFR, and smoking status. For patients who were HPV+, 7 of 11 died of distant metastasis and 6 of 7 with distant metastasis had matted nodes.
Matted nodes are a novel marker of poor prognosis in oropharyngeal SCC independent of established prognostic factors. Matted nodes may identify patients at risk for the development of distant metastasis who could benefit from systemic therapy, whereas patients without matted nodes may be candidates for de-escalation of therapy.
尽管预后较好，但仍有一群口咽鳞状细胞癌（SCC）人乳头瘤病毒（HPV）+患者经历治疗失败并死于远处转移。
对 78 例先前未经治疗的患者进行了嵌套式同期放化疗方案的回顾性分析，以将局部区域肿瘤范围的模式与远处转移相关联。生物标志物评估为：HPV 原位杂交和表皮生长因子受体（EGFR）免疫强度。
有和没有融合淋巴结的患者的 3 年疾病特异性生存率（DSS）分别为 69%和 94%（p =.003）。融合淋巴结是独立于 T 分类、HPV、EGFR 和吸烟状态的不良预后因素。对于 HPV+的患者，11 例中有 7 例死于远处转移，且 7 例有远处转移的患者中有 6 例有融合淋巴结。
融合淋巴结是口咽 SCC 中独立于既定预后因素的预后不良的新标志物。融合淋巴结可能识别出有远处转移发展风险的患者，这些患者可能受益于全身治疗，而没有融合淋巴结的患者可能是治疗降级的候选者。
