Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.
Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.
Oral Oncol. 2021 Apr;115:105140. doi: 10.1016/j.oraloncology.2020.105140. Epub 2021 Feb 3.
For oropharynx squamous cell carcinoma (OPSCC) this study aimed to: (i) compare 5-year overall survival (OS) stratification by AJCC/UICC TNM versions 7 (TNMv7) and 8 (TNMv8), (ii) determine whether changes to T and N stage groupings improve prognostication and (iii) develop and validate a model incorporating additional clinical characteristics to improve 5-year OS prediction.
All OPSCC treated with curative-intent at our institution between 2011 and 2017 were included. The primary endpoint was 5-year OS. Survival curves were produced for TNMv7 and TNMv8. A three-way interaction between T, N stage and p16 status was evaluated for improved prognostication. Cox proportional hazards modelling was used to derive a new predictive model.
Of 750 OPSCC cases, 574 (77%) were p16-positive. TNMv8 was more prognostic than TNMv7 (concordance probability estimate [CPE] ± SE = 0.72 ± 0.02 vs 0.53 ± 0.02). For p16-positive disease, TNMv8 discriminated stages II vs I (HR 2.32, 95% CI 1.47-3.67) and III vs II (HR 1.75, 95% CI 1.13-2.72). For p16-negative disease, TNMv7 and TNMv8 demonstrated poor hazard discrimination. Different T, N stage and p16-status combinations did not improve prognostication after adjusting for other factors (CPE = 0.79 vs 0.79, p = 0.998). A model for p16-positive and p16-negative OPSCC including additional clinical characteristics improved 5-year OS prediction beyond TNMv8 (c-index 0.76 ± 0.02).
TNMv8 is superior to TNMv7 for p16-positive OPSCC, but both performed poorly for p16-negative disease. A novel model incorporating additional clinical characteristics improved 5-year OS prediction for both p16-positive and p16-negative disease.
对于口咽鳞状细胞癌（OPSCC），本研究旨在：（i）比较 AJCC/UICC 第 7 版（TNMv7）和第 8 版（TNMv8）的 5 年总生存率（OS）分层，（ii）确定 T 和 N 分期分组的变化是否能改善预后，（iii）制定并验证一种纳入附加临床特征的模型以提高 5 年 OS 预测。
纳入本机构 2011 年至 2017 年期间接受根治性治疗的所有 OPSCC 患者。主要终点为 5 年 OS。为 TNMv7 和 TNMv8 生成生存曲线。评估 T、N 分期和 p16 状态之间的三向交互作用以改善预后。采用 Cox 比例风险模型推导新的预测模型。
750 例 OPSCC 患者中，574 例（77%）为 p16 阳性。与 TNMv7 相比，TNMv8 更具预后意义（一致性概率估计值[CPE]±SE=0.72±0.02 比 0.53±0.02）。对于 p16 阳性疾病，TNMv8 可区分 II 期和 I 期（HR 2.32，95%CI 1.47-3.67）和 III 期和 II 期（HR 1.75，95%CI 1.13-2.72）。对于 p16 阴性疾病，TNMv7 和 TNMv8 显示出较差的危险度区分能力。在调整其他因素后，不同的 T、N 分期和 p16 状态组合并未改善预后（CPE=0.79 比 0.79，p=0.998）。包括附加临床特征的 p16 阳性和 p16 阴性 OPSCC 模型提高了 TNMv8 对 5 年 OS 的预测能力（c 指数 0.76±0.02）。
对于 p16 阳性 OPSCC，TNMv8 优于 TNMv7，但对于 p16 阴性疾病，两者的表现均较差。一种纳入附加临床特征的新模型提高了 p16 阳性和 p16 阴性疾病的 5 年 OS 预测能力。
