Spector Matthew E, Gallagher K Kelly, Bellile Emily, Chinn Steven B, Ibrahim Mohannad, Byrd Serena, Chanowski Eric J, Walline Heather M, Moyer Jeffrey S, Prince Mark E, Wolf Gregory T, Bradford Carol R, McHugh Jonathan B, Cordell Kitrina, Carey Thomas, Worden Francis P, Eisbruch Avraham, Chepeha Douglas B
Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Head Neck. 2014 Sep;36(9):1233-40. doi: 10.1002/hed.23438. Epub 2014 Jan 20.
The current American Joint Committee on Cancer (AJCC) staging system may not accurately reflect survival in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC). The purpose of this study was to develop a system that more precisely predicts survival.
CT scans from 156 patients who underwent chemoradiation for advanced-stage oropharyngeal SCC with >2 years follow-up were reviewed. We modeled patterns of nodal metastasis associated with different survival rates. We defined HPV+ N1 as a single node <6 cm, ipsilaterally, contralaterally, or bilaterally. HPV+ N2 was defined as a single node ≥6 cm or ≥2 nodes ipsilaterally/contralaterally or ≥3 nodes bilaterally. HPV+ N3 was defined as matted nodes.
There was no significant difference in disease-specific survival (DSS; p = .14) or overall survival (OS; p = .16) by AJCC classification. In patients grouped by HPV+ N1, HPV+ N2, and HPV+ N3 nodal classification, significant differences in DSS (100%, 92%, and 55%, respectively; p = .0001) and OS (100%, 96%, and 55%, respectively; p = .0001) were found.
A staging system with reclassification of size, bilaterality, and matted nodes more accurately reflects survival differences in this cohort of patients. Review of the AJCC staging system with these criteria should be considered for HPV-positive oropharyngeal SCC.
当前美国癌症联合委员会（AJCC）分期系统可能无法准确反映人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（SCC）患者的生存率。本研究的目的是开发一种能更精确预测生存率的系统。
回顾了156例接受晚期口咽SCC放化疗且随访时间超过2年患者的CT扫描结果。我们对与不同生存率相关的淋巴结转移模式进行建模。我们将HPV+ N1定义为同侧、对侧或双侧单个直径<6 cm的淋巴结。HPV+ N2定义为单个直径≥6 cm的淋巴结或同侧/对侧≥2个淋巴结或双侧≥3个淋巴结。HPV+ N3定义为融合成团的淋巴结。
根据AJCC分类，疾病特异性生存率（DSS；p = 0.14）或总生存率（OS；p = 0.16）无显著差异。在按HPV+ N1、HPV+ N2和HPV+ N3淋巴结分类分组的患者中，发现DSS（分别为100%、92%和55%；p = 0.0001）和OS（分别为100%、96%和55%；p = 0.0001）有显著差异。
一种对淋巴结大小、双侧性和融合情况重新分类的分期系统能更准确地反映该组患者的生存差异。对于HPV阳性口咽SCC，应考虑根据这些标准对AJCC分期系统进行重新审视。
