Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia.
JAMA Otolaryngol Head Neck Surg. 2020 Aug 1;146(8):699-707. doi: 10.1001/jamaoto.2020.1019.
The association and interaction of host characteristics with prognosis in patients with oral cavity squamous cell carcinoma (OSCC) are poorly understood. There is increasing evidence that host characteristics are associated with treatment outcomes of many cancers.
To examine the host factors associated with prognosis in patients with OSCC and their interactions to create a numerical index that quantifies the prognostic capacity of these host characteristics.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with OSCC treated surgically at a tertiary care center from January 1, 1998, to December 31, 2015. From a departmental OSCC database of 1377 previously untreated patients, 68 patients with missing data on any host variable of interest within a month before the start of treatment were excluded, leaving 1309 patients. Data analysis was performed from October 21, 2019, to December 10, 2019.
Primary surgery for OSCC.
Overall survival (OS) was the primary end point, and disease-specific survival (DSS) was the secondary end point. Optimal cutoffs for each variable were identified using recursive-partitioning analysis with the classification and regression tree method using OS as the dependent variable. Body mass index (BMI) and pretreatment peripheral blood leukocyte count, platelet count, hemoglobin level, and albumin level were analyzed. A host index (H-index) was developed using independent factors associated with OS.
A total of 1309 patients (731 [55.8%] male; mean [SD] age, 62 [14.3] years) participated in the study. When including all the host-related factors in a multivariable analysis, all except BMI (hazard ratio [HR], 1.14; 95% CI, 0.80-1.63) were independently associated with outcomes. For example, compared with a hemoglobin level of 14.1 g/dL or greater, the HR for a level of 12.9 to 14.0 g/dL was 1.42 (95% CI, 1.13-1.77) and for a level of 12.8 g/dL or less was 1.51 (95% CI, 1.18-1.94), and compared with an albumin level of 4.3 g/dL or greater, the HR for a level of 3.7 to 4.2 g/dL was 1.18 (95% CI, 0.95-1.45) and for a level of 3.6 g/dL or less was 3.64 (95% CI, 2.37-5.58). An H-index of 1.4 or less was associated with a 74% 5-year OS, an H-index of 1.5 to 3.5 with a 65% 5-year OS, and an H-index of 3.6 or higher with a 38% 5-year OS; for DSS, the 5-year survival was 84%, 80%, and 64%, respectively. Compared with patients with an H-index score of 1.4 or less, patients with H-index scores of 1.5 to 3.5 (hazard ratio, 1.474; 95% CI, 1.208-1.798) and 3.6 or higher (hazard ratio, 3.221; 95% CI, 2.557-4.058) had a higher risk of death.
The findings suggest that pretreatment values of neutrophils, monocytes, lymphocytes, hemoglobin, and albumin are independently associated with prognosis in patients with OSCC. The interactions between these host factors were incorporated into a novel H-index that quantified the prognostic capacity of host characteristics associated with OSCC.
口腔鳞状细胞癌（OSCC）患者的宿主特征与预后的关联和相互作用尚未得到充分理解。越来越多的证据表明，宿主特征与许多癌症的治疗结果有关。
检查与 OSCC 患者预后相关的宿主因素及其相互作用，以创建一个数值指数，量化与 OSCC 相关的宿主特征的预后能力。
设计、地点和参与者：这项回顾性队列研究纳入了 1998 年 1 月 1 日至 2015 年 12 月 31 日在一家三级护理中心接受手术治疗的 OSCC 患者。从一个部门的 OSCC 数据库中，排除了 1377 名之前未经治疗的患者中，有 68 名患者在开始治疗前一个月内有任何感兴趣的宿主变量缺失数据，留下 1309 名患者。数据分析于 2019 年 10 月 21 日至 2019 年 12 月 10 日进行。
OSCC 的主要手术。
总生存（OS）是主要终点，疾病特异性生存（DSS）是次要终点。使用递归分区分析和分类回归树方法，使用 OS 作为因变量，确定每个变量的最佳截断值。分析体重指数（BMI）和治疗前外周血白细胞计数、血小板计数、血红蛋白水平和白蛋白水平。使用与 OS 相关的独立因素开发了一个宿主指数（H-index）。
共有 1309 名患者（731 名[55.8%]为男性；平均[标准差]年龄为 62[14.3]岁）参与了研究。当在多变量分析中包括所有与宿主相关的因素时，除 BMI（风险比[HR]，1.14；95%置信区间，0.80-1.63）外，其他所有因素都与结果独立相关。例如，与血红蛋白水平为 14.1 g/dL 或更高相比，血红蛋白水平为 12.9 至 14.0 g/dL 的 HR 为 1.42（95%置信区间，1.13-1.77），血红蛋白水平为 12.8 g/dL 或更低的 HR 为 1.51（95%置信区间，1.18-1.94），与白蛋白水平为 4.3 g/dL 或更高相比，白蛋白水平为 3.7 至 4.2 g/dL 的 HR 为 1.18（95%置信区间，0.95-1.45），白蛋白水平为 3.6 g/dL 或更低的 HR 为 3.64（95%置信区间，2.37-5.58）。H-index 为 1.4 或更低与 5 年 OS 率为 74%相关，H-index 为 1.5 至 3.5 与 5 年 OS 率为 65%相关，H-index 为 3.6 或更高与 5 年 OS 率为 38%相关；对于 DSS，5 年生存率分别为 84%、80%和 64%。与 H-index 评分低于 1.4 的患者相比，H-index 评分在 1.5 至 3.5（危险比，1.474；95%置信区间，1.208-1.798）和 3.6 或更高（危险比，3.221；95%置信区间，2.557-4.058）的患者死亡风险更高。
研究结果表明，治疗前的中性粒细胞、单核细胞、淋巴细胞、血红蛋白和白蛋白值与 OSCC 患者的预后独立相关。这些宿主因素之间的相互作用被纳入一个新的 H-index 中，该指数量化了与 OSCC 相关的宿主特征的预后能力。
