原发灶不明的癌和第 8 版头颈部肿瘤 TNM 分类。

Carcinoma of Unknown Primary and the 8th Edition TNM Classification for Head and Neck Cancer.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany.

Department of Radiooncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany.

出版信息

Laryngoscope. 2021 Sep;131(9):E2534-E2542. doi: 10.1002/lary.29499. Epub 2021 Mar 18.

DOI:10.1002/lary.29499

PMID:33734438

Abstract

OBJECTIVE

In the 8th Edition TNM Classification for Head and Neck Cancer, the classification for carcinoma of unknown primary (CUP) changed in addition to oropharyngeal carcinomas. The current classification considers extranodal extension (ENE), determination of p16 (surrogate marker for human papillomavirus), and detection of Epstein-Barr virus (EBV). The aim of this study was to investigate the influence of the new classification on the prognosis of p16-positive and p16-negative CUP and the impact of EBV proof.

METHODS

Clinical and pathological data from patients with CUP of the head and neck between 2009 and 2018 were evaluated. The 7th (UICC7) and 8th (UICC8) edition of the Union for International Cancer Control staging system were applied and compared.

RESULTS

There were 97 patients treated, 26.8% women and 73.2% men. The average age at initial diagnosis was 64.6 years. Of which, 58.8% had a documented history of smoking, 37.1% were positive for p16, 4.1% were positive for EBV, and 66% had ENE. Most of the patients were at stage III/IVa (78.4% according to UICC7). According to UICC8, p16+ patients were mainly at stage I (86.1%), and p16- at stage IVb (56.1%). P16 status (P = .002), ENE (P = .001), nodal category (TNM7, P < .001), UICC stage (TNM7, P < .001) and UICC stage (TNM8, P < .001) had a significant impact on survival in the univariate analysis. The 8th TNM classification resulted in a downstaging of p16-positive CUP syndromes and an upstaging of p16-negative syndromes.

CONCLUSION

The 8th TNM classification shows the lower UICC stage in p16-positive CUP syndromes. The prognostic significance for survival has improved from the 7th to the 8th TNM classification. LEVEL OF EVIDENCE USING THE 2011 OCEBM: Level 3. Laryngoscope, 131:E2534-E2542, 2021.

摘要

目的

在第 8 版头颈部癌症 TNM 分类中，除了口咽癌外，对不明原发灶（CUP）的分类也发生了改变。目前的分类考虑了结外扩展（ENE）、p16（人乳头瘤病毒的替代标志物）的测定以及 EBV（Epstein-Barr 病毒）的检测。本研究旨在探讨新分类对 p16 阳性和 p16 阴性 CUP 预后的影响，以及 EBV 检测的影响。

方法

评估了 2009 年至 2018 年间头颈部 CUP 患者的临床和病理数据。应用第 7 版（UICC7）和第 8 版（UICC8）国际抗癌联合会分期系统进行比较。

结果

共治疗 97 例患者，其中女性占 26.8%，男性占 73.2%。初次诊断时的平均年龄为 64.6 岁。其中，58.8%有吸烟史，37.1% p16 阳性，4.1% EBV 阳性，66%有 ENE。大多数患者处于 III/IVa 期（根据 UICC7，占 78.4%）。根据 UICC8，p16+患者主要处于 I 期（86.1%），而 p16-患者主要处于 IVb 期（56.1%）。p16 状态（P=.002）、ENE（P=.001）、淋巴结分类（TNM7，P<0.001）、UICC 分期（TNM7，P<0.001）和 UICC 分期（TNM8，P<0.001）在单因素分析中对生存有显著影响。第 8 版 TNM 分类导致 p16 阳性 CUP 综合征的分期降低，p16 阴性综合征的分期升高。