Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, 00029 HUS, Helsinki, Finland.
Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Strahlenther Onkol. 2018 Aug;194(8):759-770. doi: 10.1007/s00066-018-1309-z. Epub 2018 May 17.
To investigate the impact of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) in oropharyngeal squamous cell carcinoma (OPSCC) and the difference in their role between human papillomavirus (HPV)-positive and HPV-negative patients.
The patient cohort consists of 91 OPSCC patients treated with definitive radiochemotherapy or radiotherapy using intensity-modulated radiotherapy (IMRT). All patients had a minimum follow-up of 31 months. Volume measurements were made from computer tomography (CT) scans and HPV status was assessed by p16 immunohistochemistry. The end points were as follows: overall survival (OS), disease-free survival (DFS) and locoregional control (LRC).
pGTV was a significant independent prognostic factor for overall survival (OS; p = 0.020) in p16-negative patients. nGTV of p16-negative tumors had significant prognostic value in all end points in multivariate analyses. High-stage (III-IVc) p16-negative tumors were only associated with significantly poorer OS (p = 0.046) but not with poorer LRC or DFS when compared with the low-stage (I-II) tumors. nGTV of p16-positive tumors was an independent prognostic factor for DFS (p = 0.005) and LRC (p = 0.007) in multivariate analyses.
pGTV may serve as an independent prognostic factor in p16-negative patients and nGTV may serve as an independent prognostic factor both in p16-positive and p16-negative patients treated with radiochemotherapy or radiotherapy using IMRT. Tumor volume may have an impact on selecting patients for de-escalation protocols in the future, both in p16-positive and p16-negative patients.
探讨原发肿瘤体积（pGTV）和淋巴结肿瘤体积（nGTV）在口咽鳞状细胞癌（OPSCC）中的影响，以及 HPV 阳性和 HPV 阴性患者中它们作用的差异。
该患者队列包括 91 例接受根治性放化疗或调强放疗（IMRT）放疗的 OPSCC 患者。所有患者的随访时间均至少为 31 个月。体积测量来自 CT 扫描，HPV 状态通过 p16 免疫组化评估。终点如下：总生存期（OS）、无病生存期（DFS）和局部区域控制（LRC）。
pGTV 是 p16 阴性患者总体生存（OS）的显著独立预后因素（p=0.020）。p16 阴性肿瘤的 nGTV 在多变量分析中所有终点均具有显著的预后价值。高分期（III-IVc）p16 阴性肿瘤与低分期（I-II）肿瘤相比，仅与显著较差的 OS 相关（p=0.046），而与较差的 LRC 或 DFS 无关。p16 阳性肿瘤的 nGTV 是多变量分析中 DFS（p=0.005）和 LRC（p=0.007）的独立预后因素。
pGTV 可能是 p16 阴性患者的独立预后因素，nGTV 可能是 p16 阳性和 p16 阴性患者接受放化疗或 IMRT 放疗的独立预后因素。肿瘤体积可能会影响未来在 p16 阳性和 p16 阴性患者中选择降低治疗强度方案的患者。
