阳性淋巴结数量优于淋巴结比率和美国癌症联合委员会 N 分期，可用于预测手术治疗的头颈部鳞状细胞癌的预后。
Number of positive nodes is superior to the lymph node ratio and American Joint Committee on Cancer N staging for the prognosis of surgically treated head and neck squamous cell carcinomas.
机构信息
Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.
Department of Medicine-Oncology, Stanford University School of Medicine, Stanford, California.
出版信息
Cancer. 2016 May 1;122(9):1388-97. doi: 10.1002/cncr.29932. Epub 2016 Mar 11.
BACKGROUND
Recent changes in head and neck cancer epidemiology have created a need for improved lymph node prognostics. This article compares the prognostic value of the number of positive nodes (pN) with the value of the lymph node ratio (LNR) and American Joint Committee on Cancer (AJCC) N staging in surgical patients.
METHODS
The Surveillance, Epidemiology, and End Results database was used to identify cases of head and neck squamous cell carcinomas from 2004 to 2012. The sample was grouped by the AJCC N stage, LNR, and pN and was analyzed with Kaplan-Meier and multivariate Cox proportional hazards models. The sample was also analyzed by the site of the primary tumor.
RESULTS
This study identified 12,437 patients. Kaplan-Meier survival curves showed superior prognostic ability for LNR and pN staging in comparison with AJCC staging. Patients with a pN value > 5 had the worst overall survival (5-year survival rate, 16%). Patients with oropharyngeal tumors had better outcomes for all groupings, and a pN value > 5 for oropharyngeal cancers was associated with decreased survival. Multivariate regressions demonstrated larger hazard ratios (HRs) and a lower Akaike information criterion for the pN model versus the AJCC stage and LNR models. The HRs were 1.78 (95% confidence interval, 1.62-1.95) for a pN value of 1, 2.53 (95% confidence interval, 2.32-2.75) for a pN value of 2 to 5, and 4.64 (95% confidence interval, 4.18-5.14) for a pN value > 5.
CONCLUSIONS
The pN models demonstrated superior prognostic value in comparison with the LNR and AJCC N staging. Future modifications of the nodal staging system should be based on the pN with a separate system for oropharyngeal cancers. Future trials should consider examining adjuvant treatment escalation in patients with >5 lymph nodes. Cancer 2016;122:1388-1397. © 2016 American Cancer Society.
背景
近年来，头颈部癌症的流行病学发生了变化，因此需要改进淋巴结预后。本文比较了阳性淋巴结数量（pN）、淋巴结比值（LNR）和美国癌症联合委员会（AJCC）N 分期在手术患者中的预后价值。
方法
利用监测、流行病学和最终结果数据库，从 2004 年至 2012 年，确定头颈部鳞状细胞癌病例。根据 AJCC N 分期、LNR 和 pN 将样本分组，并采用 Kaplan-Meier 和多变量 Cox 比例风险模型进行分析。还根据原发肿瘤部位对样本进行了分析。
结果
本研究共纳入 12437 例患者。Kaplan-Meier 生存曲线显示，LNR 和 pN 分期的预后能力优于 AJCC 分期。pN 值>5 的患者总体生存率最差（5 年生存率为 16%）。口咽肿瘤患者的所有分组结果均较好，口咽癌 pN 值>5 与生存率降低相关。多变量回归显示，pN 模型的风险比（HR）较大，Akaike 信息准则（AIC）低于 AJCC 分期和 LNR 模型。pN 值为 1 的 HR 为 1.78（95%置信区间，1.62-1.95），pN 值为 2-5 的 HR 为 2.53（95%置信区间，2.32-2.75），pN 值>5 的 HR 为 4.64（95%置信区间，4.18-5.14）。
结论
与 LNR 和 AJCC N 分期相比，pN 模型显示出更好的预后价值。未来的淋巴结分期系统的修改应基于 pN，并为口咽癌建立单独的系统。未来的试验应考虑在淋巴结转移>5 的患者中，增加辅助治疗强度。癌症 2016；122:1388-1397。©2016 美国癌症协会。
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