Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA, United States.
Department of Otolaryngology-Head and Neck Surgery, Philadelphia, PA, United States.
Oral Oncol. 2018 Jul;82:138-143. doi: 10.1016/j.oraloncology.2018.05.016. Epub 2018 May 28.
To assess the pathological outcomes of surgically-managed human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) using the 8th Edition of the American Joint Committee on Cancer Staging Manual (AJCC-8ed).
A retrospective review was conducted of 156 patients with previously untreated OPSCC who underwent primary TORS between March 2010 and February 2015 to evaluate the impact of the new AJCC-8ed pathologic staging system. Only patients who had complete pathologic staging with neck dissection and at least 2 years of follow-up records or disease recurrence within 2 years were included for analysis.
Of the 156 patients, 116 patients had neck dissections and adequate follow-up data. There were 10 total recurrences, including 2 regional recurrences and 1 local recurrence. Lymph node size, number of positive lymph nodes, and presence of any positive nodes were not associated with recurrence for HPV-positive patients. The presence of extranodal extension approached significance. Pathologic N-stage was not predictive of recurrence under the AJCC-7ed or the AJCC-8ed systems. Cancer staging under the AJCC-8ed, but not the AJCC-7ed system was significantly associated with recurrence. In conclusion, pathologic node status as defined in the AJCC-8ed pathologic staging system does not appear to drive prognosis for surgically managed patients. While the new AJCC-8ed staging is an improvement in prognostication, the use of T-stage alone is still a better predictor of recurrence. TORS with adjuvant therapy determined by pathologic findings provides excellent locoregional control for HPV-positive OPSCC.
使用第 8 版美国癌症联合委员会癌症分期手册（AJCC-8ed）评估经手术治疗的人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）的病理结果。
对 2010 年 3 月至 2015 年 2 月期间接受原发性经口内镜下机器人手术（TORS）治疗的 156 例未经治疗的 OPSCC 患者进行回顾性研究，以评估新的 AJCC-8ed 病理分期系统的影响。仅纳入具有完整病理分期（包括颈部清扫术）且至少有 2 年随访记录或 2 年内疾病复发的患者进行分析。
在 156 例患者中，有 116 例患者接受了颈部清扫术和足够的随访数据。共有 10 例患者出现总复发，包括 2 例区域复发和 1 例局部复发。HPV 阳性患者的淋巴结大小、阳性淋巴结数量以及任何阳性淋巴结的存在与复发无关。淋巴结外侵犯的存在接近显著水平。AJCC-7ed 或 AJCC-8ed 系统下的病理 N 期并不能预测复发。AJCC-8ed 下的癌症分期而非 AJCC-7ed 系统与复发显著相关。总之，AJCC-8ed 病理分期系统中定义的病理淋巴结状态似乎并不能影响手术治疗患者的预后。尽管新的 AJCC-8ed 分期在预后判断方面有所改进，但仅使用 T 分期仍然是复发的更好预测指标。根据病理结果行 TORS 联合辅助治疗可为 HPV 阳性 OPSCC 提供极佳的局部区域控制。
