淋巴结比率与美国癌症联合委员会 N 分类对手术切除人乳头瘤病毒相关口咽鳞状细胞癌的预后价值。
Prognostic value of lymph node ratio versus American Joint Committee on Cancer N classification for surgically resected human papillomavirus-associated oropharyngeal squamous cell carcinoma.
机构信息
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA.
Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA.
出版信息
Head Neck. 2021 May;43(5):1476-1486. doi: 10.1002/hed.26605. Epub 2021 Jan 7.
BACKGROUND
We compared prognostic values of lymph node ratio (LNR) and AJCC 8 N classification in surgically resected human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).
METHODS
Using the National Cancer Database, we identified patients with HPV-associated OPSCC from 2010 to 2016 who underwent definitive surgical resection. Patients were analyzed by nodal grouping (LNR, N stage) and adjuvant radiation therapy(RT). Primary endpoint was overall survival.
RESULTS
We identified 4166 patients. Survival analysis showed significant improvement for LNR≤6% versus >6% (5 year OS% 92.7% vs. 83.7%, p < 0.001). N classification demonstrated good prognostic ability (5 year OS% for pN0, pN1, pN2 were 91.3%, 90.1%, 78.8%, p < 0.001), but poor separation among stages (compared to pN0: pN1 HR 1.40 [95% CI 0.63, 3.09], p = 0.41; pN2 HR 2.50 [95% CI 1.08, 5.81], p = 0.033). RT improved survival in the LNR > 6% group (5 year OS% 85.4% vs. 74.9%, p < 0.001; HR 0.41 [95% CI 0.28, 0.58], p < 0.001).
CONCLUSIONS
LNR should be considered an adjunct category in future staging systems for HPV-associated OPSCC.
背景
我们比较了淋巴结比率（LNR）和 AJCC8N 分类在手术切除的人乳头瘤病毒（HPV）相关口咽鳞状细胞癌（OPSCC）中的预后价值。
方法
使用国家癌症数据库，我们从 2010 年至 2016 年确定了接受确定性手术切除的 HPV 相关 OPSCC 患者。患者按淋巴结分组（LNR、N 期）和辅助放疗（RT）进行分析。主要终点是总生存期。
结果
我们确定了 4166 名患者。生存分析显示，LNR≤6%与>6%相比，生存率显著提高（5 年 OS%为 92.7%比 83.7%，p<0.001）。N 分类显示出良好的预后能力（pN0、pN1、pN2 的 5 年 OS%分别为 91.3%、90.1%、78.8%，p<0.001），但分期之间的分离效果较差（与 pN0 相比：pN1 HR 为 1.40[95%CI 0.63,3.09]，p=0.41；pN2 HR 为 2.50[95%CI 1.08,5.81]，p=0.033）。在 LNR>6%的患者中，RT 提高了生存率（5 年 OS%为 85.4%比 74.9%，p<0.001；HR 为 0.41[95%CI 0.28,0.58]，p<0.001）。
结论
LNR 应被视为 HPV 相关 OPSCC 未来分期系统中的辅助分类。
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