常规监测影像学对检测人乳头瘤病毒相关口咽癌复发的影响。

Impact of routine surveillance imaging on detecting recurrence in human papillomavirus associated oropharyngeal cancer.

机构信息

Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.

出版信息

Oral Oncol. 2020 Apr;103:104585. doi: 10.1016/j.oraloncology.2020.104585. Epub 2020 Feb 7.

DOI:10.1016/j.oraloncology.2020.104585

PMID:32044714

Abstract

OBJECTIVES

This study examines the utility of surveillance imaging in detecting locoregional failures (LRF), distant failures (DF) and second primary tumors (SPT) in patients with human papillomavirus (HPV) associated oropharyngeal cancer (OPC) after definitive chemoradiotherapy (CRT).

METHODS AND MATERIALS

An institutional database identified 225 patients with biopsy proven, non- metastatic HPV+ OPC treated with definitive CRT between 2004 and 2015, whose initial post-treatment imaging was negative for disease recurrence (DR). Two groups were defined: patients with <2 scans/year Group 1 and patients with ≥2 scans/year Group 2. The Mann-Whitney test or Chi-square was used to determine differences in baseline characteristics between groups. Fine & Gray regression was used to detect an association between imaging frequency, DR and diagnosis of SPT.

RESULTS

Median follow up was 40.8 months. 30% of patients had ≥T3 disease and 90% had ≥ N2 disease (AJCC 7th edition). Twenty one failures (9.3%) were observed, 7 LRF and 15 DF. Six LRF occurred within 24 months and 14 DF occurred within 36 months of treatment completion. Regression analysis showed Group 2 had increased risk of DR compared to Group1 (HR 10.3; p = 0.002) albeit with more advanced disease at baseline. Five SPT were found (2 lung, 2 esophagus, and 1 oropharynx) between 4.5 and 159 months post-CRT.

CONCLUSION

Surveillance imaging seems most useful in the first 2-3 years post treatment, and is particularly important in detecting DF. Surveillance scans for SPT has a low yield, but should be considered for those meeting lung cancer screening guidelines.

摘要

目的

本研究旨在探讨监测影像学在检测人乳头瘤病毒（HPV）相关口咽癌（OPC）患者接受根治性放化疗（CRT）后局部区域复发（LRF）、远处失败（DF）和第二原发肿瘤（SPT）中的作用。

方法和材料

通过机构数据库，共确定了 225 例经活检证实、无远处转移的 HPV+ OPC 患者，他们在 2004 年至 2015 年间接受了根治性 CRT 治疗，初始治疗后影像学检查未见疾病复发（DR）。将患者分为两组：每年接受<2 次扫描的患者（Group 1）和每年接受≥2 次扫描的患者（Group 2）。采用 Mann-Whitney 检验或卡方检验比较两组间基线特征的差异。采用 Fine-Gray 回归分析来检测影像学检查频率与 DR 和 SPT 诊断之间的关联。

结果

中位随访时间为 40.8 个月。30%的患者有≥T3 期疾病，90%的患者有≥N2 期疾病（AJCC 第 7 版）。共观察到 21 例失败病例（9.3%），其中 7 例为 LRF，15 例为 DF。6 例 LRF 发生在治疗结束后 24 个月内，14 例 DF 发生在治疗结束后 36 个月内。回归分析显示，与 Group1 相比，Group2 发生 DR 的风险更高（HR 10.3；p=0.002），但基线时疾病更为晚期。在 CRT 后 4.5 至 159 个月期间，发现了 5 例 SPT（2 例肺癌、2 例食管癌和 1 例口咽癌）。