Krishnatry R, Gupta T, Murthy V, Ghosh-Laskar S, Budrukkar A, Chaturvedi P, Nair S, Nair D, Kumar P, Joshi A, Agarwal J P
Department of Radiation Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra, India.
Indian J Cancer. 2014 July-September;51(3):231-235. doi: 10.4103/0019-509X.146734.
Context: Various studies have shown the important risk factors for distant metastasis in head and neck cancer (HNC) which are present in most of the patients in developing countries. Identification of factors on the basis of time to distant metastasis (TDM) can help in future trials targeting smaller subgroups. Aims and Objectives: To identify the factors that predict TDM in radically treated HNC patients. Settings and Design: Retrospective audit. Materials and Methods: Retrospective audit of the prospectively maintained electronic database of a single HNC radiotherapy clinic from 1990 to 2010 was done to identify radically treated patients of HNC who developed distant metastasis. Univariate and multivariate analysis were done to identify baseline (demographic, clinical, pathological, and treatment) factors which could predict TDM, early time to metastasis (ETM; <12 months), intermediate time to metastasis (ITM; 12-24 months), and late time to metastasis (LTM; >2 years) using Kaplan Meier and Cox regression analysis, respectively. Results: One hundred patients with distant metastasis were identified with a median TDM of 7.4 months; 66 had ETM, 17 had ITM, and 17 had LTM. On multivariate analysis, the nodal stage 2-3 (N2/3) was the only baseline factor independently predicting TDM, ETM, and ITM, whereas none of the baseline factors predicted LTM. Conclusions: Higher nodal burden (N2/3) is associated with both ETM and ITM, and calls for aggressive screening, systemic therapy options, and surveillance. It is difficult to predict patients who are at a risk of developing LTM with baseline factors alone and evaluation of biological data is needed.
多项研究表明，头颈癌（HNC）远处转移的重要风险因素在发展中国家的大多数患者中都存在。根据远处转移时间（TDM）确定相关因素有助于未来针对较小亚组的试验。目的：确定根治性治疗的头颈癌患者中预测TDM的因素。研究地点和设计：回顾性审计。材料与方法：对1990年至2010年单一头颈癌放疗诊所前瞻性维护的电子数据库进行回顾性审计，以确定发生远处转移的根治性治疗的头颈癌患者。分别使用Kaplan Meier和Cox回归分析进行单因素和多因素分析，以确定可预测TDM、早期转移时间（ETM；<12个月）、中期转移时间（ITM；12 - 24个月）和晚期转移时间（LTM；>2年）的基线（人口统计学、临床、病理和治疗）因素。结果：确定了100例有远处转移的患者，中位TDM为7.4个月；66例有ETM，17例有ITM，17例有LTM。多因素分析显示，淋巴结分期2 - 3期（N2/3）是唯一独立预测TDM、ETM和ITM的基线因素，而没有基线因素可预测LTM。结论：较高的淋巴结负荷（N2/3）与ETM和ITM均相关，需要积极的筛查、全身治疗方案和监测。仅靠基线因素难以预测有发生LTM风险的患者，需要评估生物学数据。
