Peters Thomas T, Senft Asaf, Hoekstra Otto S, Castelijns J A, Witte Birgit I, Leemans C René, de Bree Remco
Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Oral Oncol. 2015 Mar;51(3):267-71. doi: 10.1016/j.oraloncology.2014.12.006. Epub 2014 Dec 29.
Previously identified high risk factors for development of distant metastases are: three or more lymph node metastases, bilateral lymph node metastases, lymph nodes larger than 6cm, low jugular lymph node metastases, locoregional tumor recurrence and second primary tumors. The aims of this study were to validate these specific risk factors and to investigate the impact of time (i.e. during screening or follow-up) of detection of distant metastases on survival.
From a total of 301 HNSCC patients with high risk factors who were scheduled for extensive treatment and underwent pretreatment screening on distant metastases using chest CT and/or whole body PET(-CT) (in some patients combined with whole body MRI), the high risk factors, the development and time point of distant metastases and survival were analyzed.
Forty-four percent developed distant metastases. Multivariate analysis revealed that bilateral lymph node metastases is the strongest predictive factor. Locoregional recurrence and second primary tumor were the risk factors associated with the lowest cumulative incidence. However, if the risk factor locoregional recurrence was split into local and regional recurrences, regional recurrence became a high risk factor. The more high risk factors a patient had the lower the 5-year distant metastases free survival was. Patients with distant metastases detected pretreatment has a significant worse survival (corrected for lead time bias) compared to patients with distant metastases diagnosed during follow-up.
The validity of three or more lymph node metastases, bilateral lymph node metastases, lymph nodes larger than 6cm, low jugular lymph node metastases and regional recurrence as high risk factors for the development of distant metastases was confirmed. If more high risk factors are present the cumulative incidence of distant metastases increases significantly. The detection of distant metastases by pretreatment screening worsens the overall survival as compared to distant metastases detected during follow-up.
先前确定的远处转移发生的高危因素包括：三个或更多淋巴结转移、双侧淋巴结转移、淋巴结大于6cm、颈下淋巴结转移、局部区域肿瘤复发和第二原发肿瘤。本研究的目的是验证这些特定的危险因素，并研究远处转移检测时间（即在筛查或随访期间）对生存的影响。
对总共301例具有高危因素的头颈部鳞状细胞癌患者进行分析，这些患者计划接受广泛治疗，并在治疗前使用胸部CT和/或全身PET（-CT）（部分患者联合全身MRI）对远处转移进行筛查，分析其高危因素、远处转移的发生情况、时间点及生存情况。
44%的患者发生了远处转移。多因素分析显示双侧淋巴结转移是最强的预测因素。局部区域复发和第二原发肿瘤是累积发病率最低的危险因素。然而，如果将局部区域复发这一危险因素分为局部复发和区域复发，则区域复发成为高危因素。患者拥有的高危因素越多，5年无远处转移生存率越低。与随访期间诊断为远处转移的患者相比，治疗前检测到远处转移的患者生存情况明显更差（校正了提前期偏倚）。
证实了三个或更多淋巴结转移、双侧淋巴结转移、淋巴结大于6cm、颈下淋巴结转移和区域复发作为远处转移发生高危因素的有效性。如果存在更多高危因素，远处转移的累积发病率会显著增加。与随访期间检测到的远处转移相比，治疗前筛查发现远处转移会使总生存情况恶化。
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