Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
Cancer. 2021 Sep 1;127(17):3092-3106. doi: 10.1002/cncr.33611. Epub 2021 May 6.
The oncologic outcomes of surgery alone for patients with American Joint Committee on Cancer 7th edition (AJCC 7th) pN2a and pN2b human papillomavirus-associated oropharynx squamous cell carcinoma (HPV+OPSCC) are not clear.
The authors performed a 12-institution retrospective study of 344 consecutive patients with HPV+OPSCC (AJCC 7th pT0-3 N3 M0) treated with surgery alone with 6 months or more of follow-up using univariate and multivariate analyses.
The 2-year outcomes for the entire cohort were 91% (182 of 200) disease-free survival (DFS), 100% (200 of 200) disease-specific survival (DSS), and 98% (200 of 204) overall survival (OS). The 18 recurrences within 2 years were 88.9% (16 of 18) local and/or regional recurrences and 11.1% (2 of 18) distant metastases. Recurrences were not significantly associated with smoking, pT stage, or pN stage. The 16 patients with locoregional recurrences within 2 years all underwent successful salvage treatments (median follow-up after salvage: 13.1 months), 43.8% (7 of 16) of whom underwent salvage surgery alone for a 2-year overall salvage radiation need of 4.5% (9 of 200). The 2-year outcomes for the 59 evaluable patients among the 109 AJCC 7th pT0-2 N2a-N2b patients with 1 to 3 pathologic lymph nodes (LNs) were as follows: local recurrence, 3.4% (2 of 59); regional recurrence, 8.4% (5 of 59); distant metastases, 0%; DFS, 88.1% (52 of 59); DSS, 100% (59 of 59); OS, 96.7% (59 of 61); and salvage radiation, 5.1% (3 of 59).
With careful selection, surgery alone for AJCC 7th pT0-T2N0-N2b HPV+OPSCC with zero to 3 pathologic LNs without perineural invasion, extranodal extension, or positive margins results in high DFS, DSS, OS, and salvage treatment success. Because of the short-term follow-up, these data support further investigation of treatment de-escalation in this population.
对于美国癌症联合委员会第 7 版（AJCC 7 版）pN2a 和 pN2b 人乳头瘤病毒相关口咽鳞状细胞癌（HPV+OPSCC）患者，单纯手术的肿瘤学结果尚不清楚。
作者对 344 例连续接受 HPV+OPSCC（AJCC 7 版 pT0-3 N3 M0）单纯手术治疗且随访时间超过 6 个月的患者进行了 12 个机构的回顾性研究，采用单因素和多因素分析。
整个队列的 2 年结果为无疾病生存率（DFS）91%（182/200），疾病特异性生存率（DSS）100%（200/200），总生存率（OS）98%（200/204）。2 年内的 18 例复发中，88.9%（16/18）为局部和/或区域复发，11.1%（2/18）为远处转移。复发与吸烟、pT 分期或 pN 分期无显著相关性。2 年内 16 例局部区域复发患者均接受了成功的挽救治疗（挽救治疗后中位随访时间：13.1 个月），43.8%（7/16）患者仅接受挽救性手术，2 年挽救性放疗需要率为 4.5%（200 例中有 9 例）。109 例 AJCC 7 版 pT0-2N2a-N2b 患者中，1 至 3 个病理淋巴结（LN）的 59 例可评估患者的 2 年结果如下：局部复发率 3.4%（2/59）；区域复发率 8.4%（5/59）；远处转移率 0%；DFS 为 88.1%（52/59）；DSS 为 100%（59/59）；OS 为 96.7%（59/61）；挽救性放疗率为 5.1%（3/59）。
对于 AJCC 7 版 pT0-T2N0-N2b 伴 0 至 3 个无神经周围侵犯、结外扩展或阳性切缘的 HPV+OPSCC 患者，经仔细选择后，单纯手术治疗可获得较高的 DFS、DSS、OS 和挽救治疗成功率。由于随访时间较短，这些数据支持在该人群中进一步探索治疗降级。
