Xing Yan, Zhang Jianjun, Lin Heather, Gold Kathryn A, Sturgis Erich M, Garden Adam S, Lee J Jack, William William N
Department of Medicine, Harvard Medical School/Mount Auburn Hospital, Cambridge, Massachusetts.
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2016 Feb 15;122(4):534-45. doi: 10.1002/cncr.29780. Epub 2015 Nov 10.
The current head and neck squamous cell carcinoma (HNSCC) staging system may not capture the full prognostic implications of regional lymph node involvement. This study investigated the impact of the level of lymph node metastasis (LNM) on survival.
The Surveillance, Epidemiology, and End Results registry was queried for oral cavity (OC), oropharynx (OP), larynx (LAR), and hypopharynx (HP) HNSCC. A multivariate Cox proportional hazards model was used to evaluate whether the level of LNM was an independent prognostic factor. Site-specific recursive-partitioning analysis was performed to classify patients into different risk groups.
In all, 14,499 patients, including OC (n = 2463), OP (n = 8567), LAR (n = 2332), and HP patients (n = 1137), were analyzed. Both the American Joint Committee on Cancer (AJCC) N classification and the level of LNM showed significant effects on overall survival (OS) in patients with OC, OP, or LAR HNSCC but not in patients with HP HNSCC. In patients with N2 disease, the AJCC subclassification (N2a, N2b, or N2c) was significantly associated with the OS of patients with OP and LAR HNSCC but not with the OS of patients with OC or HP HNSCC, whereas the level of LNM (primary, secondary, or tertiary) was significantly associated with the OS of patients with OC, OP, and LAR HNSCC but not HP HNSCC. With recursive-partitioning analysis, a simple, primary site-specific prognostic tool integrating the AJCC T and N classifications and the level of LNM was designed, and it could be easily used by health care providers in clinic.
The level of LNM is an independent prognostic factor for patients with locally advanced HNSCC and could add to the prognostic value of AJCC T and N classifications in patients with locally advanced HNSCC.
当前的头颈部鳞状细胞癌（HNSCC）分期系统可能无法完全体现区域淋巴结受累的全部预后意义。本研究调查了淋巴结转移水平（LNM）对生存的影响。
查询监测、流行病学和最终结果登记处中口腔（OC）、口咽（OP）、喉（LAR）和下咽（HP）的HNSCC病例。采用多变量Cox比例风险模型评估LNM水平是否为独立的预后因素。进行特定部位的递归划分分析，将患者分为不同风险组。
共分析了14499例患者，包括OC患者（n = 2463）、OP患者（n = 8567）、LAR患者（n = 2332）和HP患者（n = 1137）。美国癌症联合委员会（AJCC）的N分类和LNM水平对OC、OP或LAR HNSCC患者的总生存期（OS）均有显著影响，但对HP HNSCC患者无显著影响。在N2期疾病患者中，AJCC亚分类（N2a、N2b或N2c）与OP和LAR HNSCC患者的OS显著相关，但与OC或HP HNSCC患者的OS无关，而LNM水平（一级、二级或三级）与OC、OP和LAR HNSCC患者的OS显著相关，但与HP HNSCC患者无关。通过递归划分分析，设计了一种简单的、结合AJCC T和N分类以及LNM水平的特定部位预后工具，临床医护人员可轻松使用。
LNM水平是局部晚期HNSCC患者的独立预后因素，可增加AJCC T和N分类对局部晚期HNSCC患者的预后价值。
