Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Laryngoscope. 2020 Apr;130(4):939-945. doi: 10.1002/lary.28059. Epub 2019 May 11.
To comprehensively examine the prognostic significance of extranodal extension (ENE) in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-positive OPSCC).
Retrospective cohort of cases diagnosed with HPV-positive OPSCC from 2010 to 2015 in the National Cancer Database. Inclusion of all OPSCC HPV-positive cases with appropriate International Classification of Diseases-0-3 codes that received surgery with a neck dissection. Univariate and multivariable analyses were conducted. Hazard ratios (HR) for the independent effects of ENE and N stage on overall survival were estimated by Cox proportional hazards regression.
Cases that were ENE-negative had the highest 5-year survival (92.6%; 95% confidence interval [CI]: 90.5%-94.7%). ENE-positive cases had the lowest 5-year survival (84.0%; 95% CI: 80.7%-87.4%). After adjusting for confounding variables, ENE-positivity was associated with almost twice the hazard of death (HR = 1.90; 95% CI: 1.35-2.67) compared to ENE-negative cases. Nodal (N) category 1, ENE-positive status was associated with an increased risk of death (HR = 1.88; 95% CI: 1.26-2.80) compared with N1, ENE-negative status. Compared to N1/ENE-negative cases, N2/ENE-positive cases had the poorest survival (HR: 2.93; 95% CI: 1.94-4.43). Both microscopic and macroscopic ENE were associated with worse outcomes compared to node-positive/ENE-negative status.
The implementation of the American Joint Committee on Cancer 8th edition staging system provides a much-improved framework to develop and discuss treatment plans for HPV-positive OPSCC. We feel that careful consideration should be given to the importance of ENE in patients with HPV-positive OPSCC.
4 Laryngoscope, 130:939-945, 2020.
全面检查人乳头瘤病毒阳性口咽鳞状细胞癌（HPV 阳性 OPSCC）中结外侵犯（ENE）的预后意义。
回顾性队列研究纳入 2010 年至 2015 年国家癌症数据库中诊断为 HPV 阳性 OPSCC 的病例。纳入所有接受手术伴颈部清扫术的 HPV 阳性 OPSCC 病例，病例均有适当的国际疾病分类-0-3 编码。进行单变量和多变量分析。采用 Cox 比例风险回归估计 ENE 和 N 期对总生存的独立影响的风险比（HR）。
ENE 阴性病例的 5 年生存率最高（92.6%；95%置信区间[CI]：90.5%-94.7%）。ENE 阳性病例的 5 年生存率最低（84.0%；95%CI：80.7%-87.4%）。在调整混杂变量后，与 ENE 阴性病例相比，ENE 阳性病例的死亡风险几乎增加了一倍（HR=1.90；95%CI：1.35-2.67）。与 N1、ENE 阴性状态相比，N 分类 1、ENE 阳性状态与死亡风险增加相关（HR=1.88；95%CI：1.26-2.80）。与 N1/ENE 阴性病例相比，N2/ENE 阳性病例的生存率最差（HR：2.93；95%CI：1.94-4.43）。与淋巴结阳性/ENE 阴性状态相比，微观和宏观的 ENE 均与较差的结局相关。
美国癌症联合委员会第 8 版分期系统的实施为制定和讨论 HPV 阳性 OPSCC 的治疗计划提供了一个大大改进的框架。我们认为，应该仔细考虑 ENE 在 HPV 阳性 OPSCC 患者中的重要性。
4 级《喉镜》，130：939-945，2020 年。
