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晚期口咽癌同步放化疗疗效的预测

Prediction of concurrent chemoradiotherapy outcome in advanced oropharyngeal cancer.

作者信息

Hasegawa Masahiro, Maeda Hiroyuki, Deng Zeyi, Kiyuna Asanori, Ganaha Akira, Yamashita Yukashi, Matayoshi Sen, Agena Shinya, Toita Takafumi, Uehara Takayuki, Suzuki Mikio

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.

Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan.

出版信息

Int J Oncol. 2014 Sep;45(3):1017-26. doi: 10.3892/ijo.2014.2504. Epub 2014 Jun 18.

Abstract

The aim of this study was to investigate human papillomavirus (HPV) infection as a predictor of concurrent chemoradiotherapy (CCRT) response and indicator of planned neck dissection (PND) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC; stage III/IV). Overall, 39 OPSCC patients (32 men, 7 women; median age 61 years, range 39-79 years) were enrolled. The primary lesion and whole neck were irradiated up to 50.4 Gy, and subsequently the primary site and metastatic lymph nodes were boosted with a further 16.2 Gy. Although several chemotherapy regimens were employed, 82.1% of OPSCC patients received the combination of nedaplatin and 5-fluorouracil. HPV-related OPSCC (16 cases) was defined as both HPV DNA-positive status by polymerase chain reaction and p16INK4a overexpression by immunohistochemistry. Patients with N2 and N3 disease received PND 2-3 months after CCRT completion. Compared to non-responders, CCRT responders showed significantly lower nodal stage (N0 to N2b) and HPV-positive status in univariate analysis. Patients with HPV-related OPSCC had longer time to treatment failure (TTF) than those with HPV-unrelated OPSCC (p=0.040). Three-year TTF was 81.3 and 47.8% in the HPV-related and HPV-unrelated groups, respectively. There were also significant differences in disease-free survival (DFS) between the two OPSCC patient groups (p=0.042). Three-year DFS was 93.8 and 66.7% in patients with HPV-related and HPV-unrelated OPSCC, respectively. Multivariate logistic analysis showed a lower risk of TTF event occurrence in HPV-related OPSCC (p=0.041) than in HPV-unrelated OPSCC. Thus, HPV testing in addition to nodal stage was useful for predicting CCRT response, especially in advanced OPSCC. Because patients who received PND showed moderate locoregional control, PND is an effective surgical procedure for controlling neck lesions in patients with advanced HPV-unrelated disease.

摘要

本研究旨在调查人乳头瘤病毒(HPV)感染情况,作为晚期口咽鳞状细胞癌(OPSCC;III/IV期)患者同步放化疗(CCRT)反应的预测指标以及计划性颈清扫术(PND)的指示指标。总体而言,共纳入39例OPSCC患者(32例男性,7例女性;中位年龄61岁,范围39 - 79岁)。对原发灶和全颈部进行50.4 Gy的照射,随后对原发部位和转移淋巴结追加16.2 Gy的照射。尽管采用了多种化疗方案,但82.1%的OPSCC患者接受了奈达铂和5-氟尿嘧啶的联合治疗。HPV相关的OPSCC(16例)定义为聚合酶链反应检测HPV DNA呈阳性且免疫组织化学检测p16INK4a过表达。N2和N3期疾病的患者在CCRT完成后2 - 3个月接受PND。在单因素分析中,与无反应者相比,CCRT反应者的淋巴结分期(N0至N2b)显著更低且HPV呈阳性。HPV相关的OPSCC患者的治疗失败时间(TTF)比HPV无关的OPSCC患者更长(p = 0.040)。HPV相关组和HPV无关组的三年TTF分别为81.3%和47.8%。两组OPSCC患者的无病生存期(DFS)也存在显著差异(p = 0.042)。HPV相关和HPV无关的OPSCC患者的三年DFS分别为93.8%和66.7%。多因素逻辑分析显示,HPV相关的OPSCC发生TTF事件的风险低于HPV无关的OPSCC(p = 0.041)。因此,除淋巴结分期外,HPV检测对于预测CCRT反应很有用,尤其是在晚期OPSCC中。由于接受PND的患者显示出适度的局部区域控制,PND是控制晚期HPV无关疾病患者颈部病变的有效外科手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c2e/4121413/7ca16325a83f/IJO-45-03-1017-g00.jpg

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