Department of Radiation Oncology, The Princess Margaret Cancer Centre/University of Toronto, Canada.
Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre/University of Toronto, Canada.
Oral Oncol. 2021 Mar;114:105167. doi: 10.1016/j.oraloncology.2020.105167. Epub 2021 Jan 25.
BACKGROUND/OBJECTIVES: We evaluate the performance between the TNM-8 versus TNM-7 cN-classification and explore the relative prognostic contribution of radiologic extranodal extension (rENE) for HPV-negative oropharyngeal cancer (HPV-OPC).
MATERIALS/METHODS: All HPV- OPC treated with IMRT between 2005 and 2016 were included. cENE was defined as unambiguous "fixation" of a neck mass or "skin involvement" on clinical examination. rENE was recorded by re-reviewing pre-treatment CT/MR. Disease-free survival (DFS) stratified by cENE or rENE were compared. Multivariable analyses (MVA) calculated the adjusted hazard ratio (aHR) for the separate cENE and rENE attributes and their combination. A refined cN-category incorporating both cENE and rENE parameters was proposed. The performance of the revision was compared to TNM-8 and TNM-7.
Of 361 HPV- OPC, 97 were cN0 and 264 were cN+ with 48 cENE+ and 72 rENE+ respectively. Median follow-up was 5.4 years. The 3-year DFS was lower in cENE+ vs cENE-negative (cENE-) (23% vs 45%; aHR = 1.68, p = 0.008) and rENE+ vs rENE-negative (rENE-) patients (29% vs 45%; aHR = 1.44, p = 0.037). The cENE+/rENE+ subset had the worse DFS vs cENE-/rENE+ or cENE-/rENE- (24%/37%/46%, p = 0.005). We propose a refined cN-category wherein any cENE-/rENE+ case is reclassified one N-stratum higher while any cENE+ case remains cN3b. The stage schema with the refined N-categorization outperformed TNM-8, and both outperformed TNM-7.
cENE and rENE are both prognostic but the cENE+/rENE+ subset has the worst outcome. The TNM-8 cN-categories improves outcome prediction compared to the TNM-7. Incorporation of rENE into TNM-8 cN-categories may further augment performance.
背景/目的：我们评估了 TNM-8 与 TNM-7 cN 分类之间的性能，并探讨了放射学外侵犯（rENE）对 HPV 阴性口咽癌（HPV-OPC）的相对预后贡献。
材料/方法：纳入 2005 年至 2016 年间接受调强放疗（IMRT）治疗的所有 HPV-OPC 患者。cENE 定义为颈部肿块的明确“固定”或临床检查中的“皮肤侵犯”。rENE 通过重新审查治疗前 CT/MR 记录。比较 cENE 或 rENE 分层的无病生存（DFS）。多变量分析（MVA）计算了单独的 cENE 和 rENE 特征及其组合的调整后的危险比（aHR）。提出了一种包含 cENE 和 rENE 参数的改良 cN 分类。将修订后的分类与 TNM-8 和 TNM-7 进行了比较。
在 361 例 HPV-OPC 中，97 例为 cN0，264 例为 cN+，其中 48 例为 cENE+，72 例为 rENE+。中位随访时间为 5.4 年。cENE+患者的 3 年 DFS 低于 cENE-（23% vs 45%；aHR=1.68，p=0.008）和 rENE-（29% vs 45%；aHR=1.44，p=0.037）。cENE+/rENE+亚组的 DFS 明显低于 cENE-/rENE+或 cENE-/rENE-（24%/37%/46%，p=0.005）。我们提出了一种改良的 cN 分类，其中任何 cENE-/rENE+病例均重新分类为一个更高的 N 期，而任何 cENE+病例仍为 cN3b。与 TNM-7 相比，具有改良 N 分类的分期方案优于 TNM-8。
cENE 和 rENE 均具有预后意义，但 cENE+/rENE+亚组的预后最差。与 TNM-7 相比，TNM-8 的 cN 分类可提高预后预测。将 rENE 纳入 TNM-8 的 cN 分类可能进一步提高性能。
