Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
Editor.
JAMA Otolaryngol Head Neck Surg. 2018 Aug 1;144(8):738-745. doi: 10.1001/jamaoto.2018.1230.
Despite advances in treatment over the last decades, recurrent head and neck cancer continues to have a poor prognosis. Prognostic accuracy may help in patient counseling.
To explore whether symptoms and clinical variables can predict prognosis in the setting of recurrent head and neck cancer.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, patients treated for head and neck cancer with curative intent at Siteman Cancer Center in St Louis, Missouri (a tertiary cancer center) between January 1, 2007, and December 31, 2014, were reviewed. The dates of data analysis were October 2016 to June 2017. Patients who developed a recurrent cancer were included, with 196 patients meeting inclusion criteria.
Symptoms and clinical findings at presentation of recurrence were recorded. Sequential sequestration and conjunctive consolidation (2 multivariable techniques) were used to create a composite staging system to predict 1-year overall survival (OS).
Among 196 patients (mean [SD] age, 61 [11] years; 166 [84.7%] of white race/ethnicity; 76.5% male), 1-year OS was 58.2% (114 of 196 patients). Time to recurrence, symptom severity stage, and rTNM stage were consolidated into a 3-category Clinical Severity Staging System, with 1-year OS rates of 90.2% (95% CI, 82.7%-97.6%) for the 61 patients classified as A, 58.1% (95% CI, 47.7%-68.6%) for the 86 patients classified as B, and 18.4% (95% CI, 7.5%-29.2%) for the 49 patients classified as C. The discriminative power of the new composite staging was better than that of the American Joint Committee on Cancer classification (C = 0.79 vs C = 0.66).
These findings suggest that clinical variables are associated with anticipated outcomes in patients with recurrent head and neck cancer.
尽管过去几十年在治疗方面取得了进步，但复发性头颈部癌症的预后仍然较差。预后准确性有助于患者咨询。
探讨症状和临床变量是否可预测头颈部癌症复发患者的预后。
设计、地点和参与者：本回顾性队列研究对密苏里州圣路易斯市 Siteman 癌症中心（三级癌症中心）于 2007 年 1 月 1 日至 2014 年 12 月 31 日期间接受根治性治疗的头颈部癌症患者进行了回顾。数据分析日期为 2016 年 10 月至 2017 年 6 月。纳入复发癌症患者，共 196 名患者符合纳入标准。
记录复发时的症状和临床发现。连续隔离和联合巩固（2 种多变量技术）用于创建一个综合分期系统，以预测 1 年总生存率（OS）。
在 196 名患者（平均[标准差]年龄，61[11]岁；166[84.7%]为白种人/西班牙裔；76.5%为男性）中，1 年 OS 为 58.2%（196 名患者中的 114 名）。复发时间、症状严重程度分期和 rTNM 分期被整合到一个 3 级临床严重程度分期系统中，61 名患者被归类为 A 级的 1 年 OS 率为 90.2%（95%CI，82.7%-97.6%），86 名患者被归类为 B 级的 1 年 OS 率为 58.1%（95%CI，47.7%-68.6%），49 名患者被归类为 C 级的 1 年 OS 率为 18.4%（95%CI，7.5%-29.2%）。新的综合分期的判别能力优于美国癌症联合委员会（AJCC）分类（C=0.79 比 C=0.66）。
这些发现表明，临床变量与复发性头颈部癌症患者的预期结果相关。
