基于转移淋巴结最大标准化摄取值、淋巴结比率和颈部淋巴结转移水平，改善 pN3b 口腔癌患者的预后分层。
Improved prognostic stratification of patients with pN3b oral cavity cancer based on maximum standardized uptake value of metastatic nodes, lymph node ratio, and level of cervical nodal metastases.
机构信息
Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.
Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
出版信息
Oral Oncol. 2021 Dec;123:105593. doi: 10.1016/j.oraloncology.2021.105593. Epub 2021 Nov 9.
OBJECTIVES
The prognosis of pN3b oral cavity squamous cell carcinoma (OCSCC) remains heterogeneous. We sought to improve the prognostic stratification of patients with pN3b OCSCC through a combined analysis of FDG-PET parameters and clinicopathological risk factors (RFs).
METHODS
From 2001 to 2019, complete data on maximum standardized uptake values derived from FDG-PET of neck metastatic nodes (SUV-nodal-max) and clinicopathological RFs were available for 257 patients with pN3b disease.
RESULTS
Using the 5-year disease-free survival (DFS) as the outcome of interest, the optimal cutoff points for SUV-nodal-max and lymph node ratio (LNR) were 15.9 and 0.17, respectively. The 5-year DFS rates/(number of cases) for patients with pN3b disease were as follows: SUV-nodal-max < 15.9 versus ≥ 15.9, 49%(226)/21%(31), p = 0.000003; LNR < 0.17 versus ≥ 0.17, 49%(230)/17%(27), p = 0.000117; absence versus presence of neck level IV/V metastases, 49%(230)/15%(27), p = 0.000004. Multivariable analyses revealed that SUV-nodal-max ≥ 15.9, LNR ≥ 0.17, and level IV/V metastases were independent prognosticators for 5-year distant metastases (DM), DFS, disease-specific survival (DSS), and overall survival (OS) rates. Based on these variables, we devised a scoring system that identified three distinct prognostic subgroups at low (score 0, n = 190), intermediate (score 1, n = 51), and high (scores 2-3, n = 16) risk. The 5-year rates of patients with pN3b disease deemed to be at low/intermediate/high risk were as follows: DM, 31%/52%/89%; DFS, 54%/26%/0%; DSS, 59%/36%/8%; OS, 42%/31%/6%, respectively; all p < 0.001.
CONCLUSIONS
A scoring system based on SUV-nodal-max, LNR, and level IV/V metastases improves the prognostic stratification of OCSCC patients with pN3b disease.
目的
pN3b 口腔鳞状细胞癌（OCSCC）的预后仍存在异质性。我们试图通过联合分析 FDG-PET 参数和临床病理危险因素（RFs）来改善 pN3b OCSCC 患者的预后分层。
方法
2001 年至 2019 年，257 例 pN3b 疾病患者的颈部转移性淋巴结（SUV-nodal-max）的 FDG-PET 最大标准化摄取值和临床病理 RFs 的完整数据可用。
结果
以 5 年无病生存率（DFS）为观察终点，SUV-nodal-max 和淋巴结比值（LNR）的最佳截断值分别为 15.9 和 0.17。pN3b 疾病患者的 5 年 DFS 率/（病例数）如下：SUV-nodal-max<15.9 与≥15.9，49%（226）/21%（31），p=0.000003；LNR<0.17 与≥0.17，49%（230）/17%（27），p=0.000117；无颈 IV/V 转移与有颈 IV/V 转移，49%（230）/15%（27），p=0.000004。多变量分析显示，SUV-nodal-max≥15.9、LNR≥0.17 和 IV/V 水平转移是 5 年远处转移（DM）、DFS、疾病特异性生存率（DSS）和总生存率（OS）的独立预后因素。基于这些变量，我们设计了一个评分系统，将 3 个不同的预后亚组分为低（评分 0，n=190）、中（评分 1，n=51）和高（评分 2-3，n=16）风险。被认为低/中/高风险的 pN3b 疾病患者的 5 年发生率如下：DM，31%/52%/89%；DFS，54%/26%/0%；DSS，59%/36%/8%；OS，42%/31%/6%，均为 p<0.001。
结论
基于 SUV-nodal-max、LNR 和 IV/V 转移的评分系统可改善 pN3b OCSCC 患者的预后分层。
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