Qin Lei, Chen Tsung-Ming, Kao Yi-Wei, Lin Kuan-Chou, Yuan Kevin Sheng-Po, Wu Alexander T H, Shia Ben-Chang, Wu Szu-Yuan
School of Statistics, University of International Business and Economics, Beijing 100029, China.
Department of Otorhinolaryngology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Cancers (Basel). 2018 Oct 22;10(10):392. doi: 10.3390/cancers10100392.
To propose a risk classification scheme for locoregionally advanced (Stages III and IV) head and neck squamous cell carcinoma (LA-HNSCC) by using the Wu comorbidity score (WCS) to quantify the risk of curative surgeries, including tumor resection and radical neck dissection. This study included 55,080 patients with LA-HNSCC receiving curative surgery between 2006 and 2015 who were identified from the Taiwan Cancer Registry database; the patients were classified into two groups, mortality ( = 1287, mortality rate = 2.34%) and survival ( = 53,793, survival rate = 97.66%), according to the event of mortality within 90 days of surgery. Significant risk factors for mortality were identified using a stepwise multivariate Cox proportional hazards model. The WCS was calculated using the relative risk of each risk factor. The accuracy of the WCS was assessed using mortality rates in different risk strata. Fifteen comorbidities significantly increased mortality risk after curative surgery. The patients were divided into low-risk (WCS, 0⁻6; 90-day mortality rate, 0⁻1.57%), intermediate-risk (7⁻11; 2.71⁻9.99%), high-risk (12⁻16; 17.30⁻20.00%), and very-high-risk (17⁻18 and >18; 46.15⁻50.00%) strata. The 90-day survival rates were 98.97, 95.85, 81.20, and 53.13% in the low-, intermediate-, high-, and very-high-risk patients, respectively (log-rank < 0.0001). The five-year overall survival rates after surgery were 70.86, 48.62, 22.99, and 18.75% in the low-, intermediate-, high-, and very-high-risk patients, respectively (log-rank < 0.0001). The WCS is an accurate tool for assessing curative-surgery-related 90-day mortality risk and overall survival in patients with LA-HNSCC.
通过使用吴式合并症评分（WCS）来量化包括肿瘤切除和根治性颈清扫在内的根治性手术风险，从而提出一种针对局部区域晚期（III期和IV期）头颈部鳞状细胞癌（LA-HNSCC）的风险分类方案。本研究纳入了2006年至2015年间从台湾癌症登记数据库中识别出的55080例行根治性手术的LA-HNSCC患者；根据手术后90天内的死亡事件，将患者分为两组，死亡组（n = 1287，死亡率 = 2.34%）和生存组（n = 53793，生存率 = 97.66%）。使用逐步多变量Cox比例风险模型确定死亡的显著风险因素。WCS通过各风险因素的相对风险计算得出。使用不同风险分层中的死亡率评估WCS的准确性。15种合并症在根治性手术后显著增加死亡风险。患者被分为低风险（WCS，0⁻6；90天死亡率，0⁻1.57%）、中风险（7⁻11；2.71⁻9.99%）、高风险（12⁻16；17.30⁻20.00%）和极高风险（17⁻18及>18；46.15⁻50.00%）分层。低、中、高和极高风险患者的90天生存率分别为98.97%、95.85%、81.20%和53.13%（对数秩检验P < 0.0001）。低、中、高和极高风险患者术后的五年总生存率分别为70.86%、48.62%、22.99%和18.75%（对数秩检验P < 0.0001）。WCS是评估LA-HNSCC患者根治性手术相关90天死亡风险和总生存的准确工具。
