局部晚期头颈部鳞状细胞癌患者的预后。肿瘤细胞 EPO 和 EPO-R 表达的影响。
Prognosis of patients with locally advanced squamous cell carcinoma of the head and neck. Impact of tumor cell expression of EPO and EPO-R.
机构信息
Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany.
出版信息
Strahlenther Onkol. 2013 Jul;189(7):559-65. doi: 10.1007/s00066-013-0320-7. Epub 2013 May 24.
BACKGROUND AND PURPOSE
This study investigated the prognostic role of tumor cell expression of erythropoietin (EPO) and its receptor (EPO-R) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) treated with surgery plus radiotherapy.
PATIENTS AND METHODS
The impact of EPO, EPO-R, and 11 additional factors on locoregional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively evaluated in 144 patients. Additional factors were age, gender, performance status, preradiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T category, N category, human papillomavirus (HPV) status, extent of resection, and chemotherapy. Univariate analyses were performed with the Kaplan-Meier method and the log-rank test, multivariate analyses with the Cox proportional hazard model.
RESULTS
On multivariate analysis, improved LRC was significantly associated with no EPO expression (risk ratio [RR] 3.72; 95 % confidence interval [CI] 1.35-15.42; p = 0.008), lower T category (RR 1.60; 95 %CI 1.14-2.32; p = 0.005), and oropharynx or larynx cancer (RR 1.23; 95 %CI 1.02-1.49; p = 0.033). Improved MFS was significantly associated with no EPO expression (RR 5.45; 95 %CI 1.13-97.81; p = 0.031), lower T category (RR 1.66; 95 %CI 1.11-2.65; p = 0.013), lower N category (RR 2.44; 95 %CI 1.04-6.66; p = 0.039), HPV positivity (RR 3.14; 95 %CI not available; p = 0.034), and oropharynx or larynx cancer (RR 1.28; 95 %CI 1.01-1.61; p = 0.041). Improved OS was significantly associated with no EPO expression (RR 4.77; 95 %CI 1.63-20.68; p = 0.003), no EPO-R expression (RR 2.36; 95 %CI 1.22-4.92; p = 0.010), lower T category (RR 1.44; 95 %CI 1.04-2.04; p = 0.027), oropharynx or larynx cancer (RR 1.30; 95 %CI 1.08-1.57; p = 0.007), and pre-RT hemoglobin ≥ 12 g/dl (RR 1.94; 95 %CI 1.03-3.65; p = 0.042).
CONCLUSION
EPO expression of tumor cells was an independent prognostic factor for LRC, MFS, and OS. EPO-R expression was an independent prognostic factor for OS.
背景与目的
本研究旨在探讨肿瘤细胞中促红细胞生成素（EPO）及其受体（EPO-R）的表达与接受手术加放疗的局部晚期头颈部鳞状细胞癌（SCCHN）患者预后的关系。
方法
对 144 例患者的 EPO、EPO-R 及 11 个附加因素对局部区域控制（LRC）、无转移生存（MFS）和总生存（OS）的影响进行了回顾性评估。附加因素包括年龄、性别、体能状态、放疗前血红蛋白水平、肿瘤部位、组织学分级、T 分期、N 分期、人乳头瘤病毒（HPV）状态、切除范围和化疗。采用 Kaplan-Meier 方法和对数秩检验进行单因素分析，采用 Cox 比例风险模型进行多因素分析。
结果
多因素分析显示，EPO 无表达（风险比[RR]3.72；95%置信区间[CI]1.35-15.42；p=0.008）、T 分期较低（RR 1.60；95%CI 1.14-2.32；p=0.005）和口咽或喉癌（RR 1.23；95%CI 1.02-1.49；p=0.033）与 LRC 改善显著相关。EPO 无表达（RR 5.45；95%CI 1.13-97.81；p=0.031）、T 分期较低（RR 1.66；95%CI 1.11-2.65；p=0.013）、N 分期较低（RR 2.44；95%CI 1.04-6.66；p=0.039）、HPV 阳性（RR 3.14；95%CI 未提供；p=0.034）和口咽或喉癌（RR 1.28；95%CI 1.01-1.61；p=0.041）与 MFS 改善显著相关。EPO 无表达（RR 4.77；95%CI 1.63-20.68；p=0.003）、EPO-R 无表达（RR 2.36；95%CI 1.22-4.92；p=0.010）、T 分期较低（RR 1.44；95%CI 1.04-2.04；p=0.027）、口咽或喉癌（RR 1.30；95%CI 1.08-1.57；p=0.007）和放疗前血红蛋白水平≥12g/dl（RR 1.94；95%CI 1.03-3.65；p=0.042）与 OS 改善显著相关。
结论
肿瘤细胞中 EPO 的表达是 LRC、MFS 和 OS 的独立预后因素。EPO-R 的表达是 OS 的独立预后因素。
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