Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Irradiation Immunity Interaction Lab, John Curtin School of Medical Research, Canberra Hospital and The Australian National University, Canberra, Australian Capital Territory, Australia.
J Med Imaging Radiat Oncol. 2020 Apr;64(2):271-278. doi: 10.1111/1754-9485.12995. Epub 2020 Feb 9.
Appropriate selection of head and neck squamous cell cancer (HNSCC) patients for curative treatment is difficult, and it is a very understudied issue. The aim of this study was to review the outcomes of curative intent treatment in non-p16 positive HNSCC patients assessed as having borderline curability.
A single institution retrospective review of the clinical outcomes of non-p16 positive HNSCC patients with borderline curability. Predefined criteria for borderline curability were as follows: (i) T4 and/or N3 disease; or (ii) ECOG status ≥2; or (iii) age ≥75 years.
A total of 114 patients were identified. A total of 56 had N3/T4, 32 were >ECOG 2 and 57 were >75 years. A total of 29 had two or more borderline curability criteria. Progression-free survival rate (PFS) at 1 and 2 years was 72% (95% confidence interval (CI), 63-79) and 53% (95% CI, 43-62), respectively. Overall survival (OS) at 1 and 2 years was 76% (95% CI, 67-83) and 61% (95% CI, 51-69), respectively. On multivariable analysis, the only independent prognostic factor for OS was the adult comorbidity evaluation-27 (ACE-27) grade (HR 1.4; 95% CI, 1.1-1.8; P = 0.018).
Patients with borderline curability criteria treated with curative intent achieved good PFS and OS. ACE-27 was an important prognostic factor in this population.
准确选择适合治愈性治疗的头颈部鳞状细胞癌（HNSCC）患者是困难的，这也是一个研究不足的问题。本研究旨在回顾评估为边界可治愈性的非 p16 阳性 HNSCC 患者的治愈性意图治疗的结果。
对具有边界可治愈性的非 p16 阳性 HNSCC 患者的临床结局进行单机构回顾性研究。边界可治愈性的预设标准如下：（i）T4 和/或 N3 疾病；或（ii）ECOG 状态≥2；或（iii）年龄≥75 岁。
共确定了 114 例患者。共有 56 例患者为 N3/T4，32 例患者为 ECOG 状态>2，57 例患者年龄>75 岁。共有 29 例患者具有两个或更多边界可治愈性标准。1 年和 2 年的无进展生存率（PFS）分别为 72%（95%可信区间[CI]，63-79）和 53%（95% CI，43-62）。1 年和 2 年的总生存率（OS）分别为 76%（95% CI，67-83）和 61%（95% CI，51-69）。多变量分析显示，OS 的唯一独立预后因素是成人合并症评估-27（ACE-27）评分（HR 1.4；95% CI，1.1-1.8；P=0.018）。
接受治愈性意图治疗的具有边界可治愈性标准的患者获得了良好的 PFS 和 OS。ACE-27 是该人群中的一个重要预后因素。
