美国癌症联合委员会第八版癌症分期系统在经口机器人手术治疗的人乳头瘤病毒相关口咽癌中的应用
Application of the Eighth Edition American Joint Committee on Cancer Staging System for HPV-Related Oropharyngeal Cancer Treated With Transoral Robotic Surgery.
作者信息
Badhey Arvind K, Olson Ashley, Kadakia Sameep, Russo Jack, Ting Peter, Khalid Mian, Yao Mike, Teng Marita S, Genden Eric M, Miles Brett A, Chai Raymond L
机构信息
New York Eye and Ear Infirmary of Mount Sinai.
Department of Population Health Science and Policy.
出版信息
Laryngoscope. 2018 May;128(5):1133-1139. doi: 10.1002/lary.26948. Epub 2017 Oct 9.
OBJECTIVE
Analyze patients treated with transoral robotic surgery (TORS) in the context of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.
METHODS
Retrospective cohort study including 110 human papillomavirus-related oropharyngeal cancer (HPV+OPC) patients with a minimum 1-year follow-up treated with TORS between 2007 to 2016. Kaplan-Meier methods were used to estimate 3-year disease-free survival and assess differences in recurrence.
RESULTS
One hundred and ten patients with a median follow-up of 54 months were analyzed. Of those, 85% of patients were male, with a median age of 60. Twenty-two percent of patients received no adjuvant therapy; 43% received adjuvant radiation; and 35% underwent adjuvant chemoradiation. Extracapsular spread was identified in 24% of patients. Overall survival was 100%, with estimated 3-year disease-free survival (DFS) (95% confidence interval) of 87% (77, 93). Under the seventh edition of the AJCC, 5% of patients were stage I; 11% were stage II; 26% were stage III; and 57% were stage IVa. Twenty-seven patients (25%) were upstaged on final pathology, whereas 15 patients (14%) were downstaged. Under the eighth edition of the AJCC, 94% of patients were stage I for both clinical and pathologic staging systems. Six patients (6%) were upstaged on final pathology, whereas six patients (6%) were downstaged. No factors demonstrated statistical significance for DFS. Within pathologic stage I, Kaplan-Meier estimates for DFS did not reach statistical significance.
CONCLUSION
The majority of patients undergoing TORS for HPV + OPC are stage I under the eighth edition of the AJCC staging system, with limited pathologic re-staging compared with the prior system. Oncologic outcomes are favorable for this group. No clinicopathologic features are significant for DFS within pathologic stage I.
LEVEL OF EVIDENCE
2b. Laryngoscope, 128:1133-1139, 2018.
目的
在美国癌症联合委员会（AJCC）第八版分期系统的背景下，分析经口机器人手术（TORS）治疗的患者情况。
方法
回顾性队列研究，纳入2007年至2016年间接受TORS治疗且至少随访1年的110例人乳头瘤病毒相关口咽癌（HPV+OPC）患者。采用Kaplan-Meier方法估计3年无病生存率并评估复发差异。
结果
分析了110例患者，中位随访时间为54个月。其中，85%为男性，中位年龄为60岁。22%的患者未接受辅助治疗；43%接受辅助放疗；35%接受辅助放化疗。24%的患者发现有包膜外扩散。总生存率为100%，估计3年无病生存率（DFS）（95%置信区间）为87%（77，93）。在AJCC第七版分期系统下，5%的患者为I期；11%为II期；26%为III期；57%为IVa期。27例患者（25%）在最终病理检查时分期上调，而15例患者（14%）分期下调。在AJCC第八版分期系统下，94%的患者在临床和病理分期系统中均为I期。6例患者（6%）在最终病理检查时分期上调，而6例患者（6%）分期下调。没有因素对DFS显示出统计学意义。在病理I期内，Kaplan-Meier估计的DFS未达到统计学意义。
结论
在AJCC第八版分期系统下，大多数接受TORS治疗的HPV+OPC患者为I期，与先前系统相比，病理重新分期有限。该组患者的肿瘤学结局良好。在病理I期内，没有临床病理特征对DFS具有显著意义。
证据级别
2b。《喉镜》，2018年，第128卷，第1133 - 1139页。
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