Lo Wu-Chia, Wu Chen-Tu, Wang Cheng-Ping, Yang Tsung-Lin, Lou Pei-Jen, Ko Jeng-Yuh, Chang Yih-Leong
Department and Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, 100, Taiwan.
Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Ann Surg Oncol. 2017 Jun;24(6):1707-1713. doi: 10.1245/s10434-017-5770-1. Epub 2017 Jan 27.
This study aimed to investigate the clinicopathologic prognostic predictors of stage 4 hypopharyngeal cancer and to extend the traditional tumor-node-metastasis classification system to advance its predictive ability.
The study enrolled 120 patients with pathologically stage 4 hypopharyngeal cancer treated with pharyngolaryngectomy and neck dissection between 2001 and 2007.
The study showed a 5-year overall survival (OS) of 44.6%, a disease-specific survival (DSS) of 51.6%, and a disease-free survival (DFS) of 48% for all the patients. In the multivariate analysis, a lymph node (LN) ratio of 0.113 or higher was a significant poor prognostic factor for OS (hazard ratio [HR] 1.89; 95% confidence interval [CI] 1.17-3.05; p = 0.009), DSS (HR 2.17; 95% CI 1.29-3.64; p = 0.003), and DFS (HR, 2.24; 95% CI 1.12-4.52; p = 0.024) in stage 4 hypopharyngeal cancer. In addition, pretreatment neutrophil-lymphocyte ratio, lymphovascular invasion, and margin status also were predictors of survival outcomes. Furthermore, the study found that disease recurrence differed significantly between the patients with a LN ratio of 0.113 or higher (68.2%) and those with a LN ratio lower than 0.113 (39.5%) (p = 0.002).
A LN ratio of 0.113 or higher is a strong predictor of disease recurrence and survival for patients with stage 4 hypopharyngeal cancer.
本研究旨在探究下咽癌4期的临床病理预后预测因素，并扩展传统的肿瘤-淋巴结-转移分类系统以提高其预测能力。
本研究纳入了2001年至2007年间接受咽喉切除术和颈部清扫术治疗的120例病理分期为4期的下咽癌患者。
研究显示，所有患者的5年总生存率（OS）为44.6%，疾病特异性生存率（DSS）为51.6%，无病生存率（DFS）为48%。在多因素分析中，淋巴结（LN）比率为0.113或更高是下咽癌4期患者OS（风险比[HR] 1.89；95%置信区间[CI] 1.17 - 3.05；p = 0.009）、DSS（HR 2.17；95% CI 1.29 - 3.64；p = 0.003）和DFS（HR 2.24；95% CI 1.12 - 4.52；p = 0.024）的显著不良预后因素。此外，治疗前中性粒细胞与淋巴细胞比率、淋巴管浸润和切缘状态也是生存结果的预测因素。此外，研究发现，LN比率为0.113或更高的患者（68.2%）与LN比率低于0.113的患者（39.5%）之间疾病复发存在显著差异（p = 0.002）。
LN比率为0.113或更高是下咽癌4期患者疾病复发和生存的有力预测因素。
