Murphy Colin T, Devarajan Karthik, Wang Lora S, Mehra Ranee, Ridge John A, Fundakowski Christopher, Galloway Thomas J
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, United States.
Oral Oncol. 2015 Nov;51(11):1034-1040. doi: 10.1016/j.oraloncology.2015.09.001. Epub 2015 Oct 5.
To assess the relationship between tumor-specific growth rate (TSGR) and oropharyngeal cancer (OPC) outcomes in the HPV era.
METHODS/MATERIALS: Primary tumor volume differences between a diagnostic and secondary scan separated ⩾7days without interval treatment were used to estimate TSGR, defined as percent volume growth/day derived from primary tumor volume doubling time for 85 OPC patients with known p16 status and smoking pack-years managed with (chemo)radiation. Variables were analyzed using Kruskal-Wallis or Fisher's exact test as appropriate. Log-rank tests and Cox proportional models analyzed endpoints. Using concordance probability estimates (CPE), TSGR was incorporated into RTOG 0129 risk grouping (0129RG) to assess whether TSGR could improve prognostic accuracy.
Median time between scans was 35days (range 8-314). Median follow up was 26months (range 1-76). The 0129RG classification was: 56% low, 25% intermediate, and 19% high risk. Median TSGR was 0.74%/day (range 0.01-4.25) and increased with 0129RG low (0.41%), intermediate (0.57%) and high (1.23%) risk, respectively (p=0.015). TSGR independently predicted for TF (TSGR: HR (95%CI)=2.79, 1.67-4.65, p<0.001) in the Cox model. On CPE, prognostic accuracy for TF, disease-free survival and overall survival was improved when 0129RG was combined with TSGR. Dichotomizing 0129RG by median TSGR yielded no observed recurrences in low risk patients with TSGR<0.74% and demonstrated significant difference for intermediate risk (8% vs. 50% for TSGR<0.74% vs. ⩾0.74%, respectively, p<0.001).
Tumor-specific growth rate correlates with increasing 0129RG and predicts treatment failure, potentially improving the prognostic strength and risk stratification of established 0129 risk groups.
评估人乳头瘤病毒（HPV）时代肿瘤特异性生长率（TSGR）与口咽癌（OPC）预后之间的关系。
方法/材料：对于85例已知p16状态和吸烟包年数且接受（化疗）放疗的OPC患者，利用诊断性扫描与二次扫描之间至少间隔7天且无间隔治疗情况下的原发肿瘤体积差异来估计TSGR，TSGR定义为根据原发肿瘤体积倍增时间得出的每日体积增长率。根据情况使用Kruskal-Wallis检验或Fisher精确检验分析变量。采用对数秩检验和Cox比例模型分析终点。利用一致性概率估计（CPE），将TSGR纳入放射肿瘤学组（RTOG）0129风险分组（0129RG），以评估TSGR是否能提高预后准确性。
扫描之间的中位时间为35天（范围8 - 314天）。中位随访时间为26个月（范围1 - 76个月）。0129RG分类为：低风险56%，中风险25%，高风险19%。TSGR中位数为0.74%/天（范围0.01 - 4.25），并分别随0129RG低风险（0.41%）、中风险（0.57%）和高风险（1.23%）而增加（p = 0.015）。在Cox模型中，TSGR独立预测治疗失败（TSGR：风险比（HR）（95%置信区间）= 2.79，1.67 - 4.65，p < 0.001）。在CPE方面，当0129RG与TSGR结合时，治疗失败、无病生存期和总生存期的预后准确性得到提高。按TSGR中位数对0129RG进行二分法分析，TSGR<0.74%的低风险患者未观察到复发，且中风险患者存在显著差异（TSGR<0.74%与≥0.74%时分别为8% vs. 50%，p < 0.001）。
肿瘤特异性生长率与0129RG增加相关，并预测治疗失败，可能会提高既定0129风险组的预后强度和风险分层。
