多灶性回归和病理反应预测头颈部鳞状细胞癌新辅助化疗后的复发。
Multifocal regression and pathologic response predicts recurrence after neoadjuvant chemotherapy in head and neck squamous cell carcinoma.
机构信息
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore(1).
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
出版信息
Oral Oncol. 2021 Nov;122:105520. doi: 10.1016/j.oraloncology.2021.105520. Epub 2021 Sep 11.
OBJECTIVES
Complete pathological response after neoadjuvant chemotherapy (NAC) in head and neck squamous cell carcinomas (HNSCC) is a good prognostic factor. Multifocal regression post-NAC in breast cancer has proven to impact locoregional control (LRC) but has not been evaluated in HNSCC. We evaluate the impact of multifocal regression and major pathologic response (MPR) on survival indices in HNSCC.
MATERIALS AND METHODS
Retrospective review of HNSCC patients receiving NAC followed by surgery with curative intent between March 2016 to March 2019 at MD Anderson Cancer Center. Tumor focality (uni- or multifocal), pathologic response and other pathologic data were collected. MPR was defined as ≤ 10% residual tumor. Overall survival (OS) and LRC were analyzed and multivariate Cox regression analysis was performed.
RESULTS
101 patients were analyzed, with 18.8% pathologic complete response, 18.8% with 1-10% viable tumor and 60.4% with > 10% viable tumor. 61 (60.4%) had unifocal disease while 19 (18.8%) had multifocal disease. Tumor focality was significantly associated with LRC but not OS, where the 3-year LRC was 82%, 69% and 52% (p = 0.015) for no viable tumor, unifocal disease and multifocal disease respectively. On multivariate analysis, multifocal disease (HR 10.43; 95 %CI 1.24-87.5) and extranodal extension (HR 4.4; 95 %CI 1.60-12.07) continued to be significant independent predictors of LRC. MPR group displayed significantly better 3-year OS (75% vs 51%, p = 0.041) and 3-year LRC (80% vs 62%, p = 0.011) than those with > 10% viable tumor.
CONCLUSION
Multifocal regression and less than MPR after NAC in HNSCC predicts for locoregional recurrence and should be routinely reported.
目的
新辅助化疗（NAC）后头颈部鳞状细胞癌（HNSCC）的完全病理缓解是一个良好的预后因素。乳腺癌中 NAC 后的多灶性消退已被证明会影响局部区域控制（LRC），但尚未在 HNSCC 中进行评估。我们评估了 HNSCC 中多灶性消退和主要病理反应（MPR）对生存指标的影响。
材料和方法
回顾性分析 2016 年 3 月至 2019 年 3 月期间在 MD 安德森癌症中心接受 NAC 后行根治性手术的 HNSCC 患者。收集肿瘤的局灶性（单灶或多灶）、病理反应和其他病理数据。MPR 定义为≤10%残留肿瘤。分析总生存期（OS）和 LRC，并进行多变量 Cox 回归分析。
结果
共分析了 101 例患者，其中病理完全缓解率为 18.8%，1-10%存活肿瘤率为 18.8%，>10%存活肿瘤率为 60.4%。61 例（60.4%）为单灶性疾病，19 例（18.8%）为多灶性疾病。肿瘤局灶性与 LRC 显著相关，但与 OS 无关，无存活肿瘤、单灶性疾病和多灶性疾病的 3 年 LRC 分别为 82%、69%和 52%（p=0.015）。多变量分析显示，多灶性疾病（HR 10.43；95%CI 1.24-87.5）和结外扩展（HR 4.4；95%CI 1.60-12.07）仍然是 LRC 的独立显著预测因素。MPR 组的 3 年 OS（75%比 51%，p=0.041）和 3 年 LRC（80%比 62%，p=0.011）明显优于>10%存活肿瘤组。
结论
HNSCC 中 NAC 后的多灶性消退和低于 MPR 预测局部区域复发，应常规报告。
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