Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Int J Cancer. 2022 Apr 15;150(8):1329-1340. doi: 10.1002/ijc.33876. Epub 2021 Dec 2.
We compare outcomes in two large-scale contemporaneously treated HPV-positive (HPV+) oropharynx cancer (OPC) cohorts treated with definitive radiotherapy/chemoradiotherapy (RT/CRT). p16-confirmed HPV+ OPC treated between 2007 and 2015 at PMH and DAHANCA were identified. Locoregional failure (LRF), distant metastasis (DM), and overall survival (OS) were compared. Multivariable analysis (MVA) calculated adjusted-hazard-ratio (aHR) with 95% confidence interval (95% CI), adjusting for cohort, age, gender, performance status, smoking pack-years, T-category and N-category and chemotherapy. Compared to PMH (n = 701), DAHANCA (n = 1174) contained lower TNM-8T-categories (T1-T2: 77% vs 56%), N-categories (N0-N1: 77% vs 67%) and stages (stage I: 63% vs 44% (all P < .001). PMH used standard-fractionation CRT in 69% (481) while 31% (220) received hypofractionated or moderately accelerated RT-alone. All DAHANCA patients were treated with moderately accelerated RT; 96% (1129) received nimorazole (NIM) and 73% (856) concurrent weekly cisplatin. DAHANCA had shorter overall-treatment-time (P < .001), lower gross tumor (66-68 vs 70 Gy) and elective neck (50 vs 56 Gy) doses. Median follow-up was 4.8 years. DAHANCA had higher 5-year LRF (13% vs 7%, aHR = 0.47 [0.34-0.67]), comparable DM (7% vs 12%, aHR = 1.32 [0.95-1.82]), but better OS (85% vs 80%, aHR = 1.30 [1.01-1.68]). CRT patients had a lower risk of LRF (aHR 0.56 [0.39-0.82]), DM (aHR 0.70 [0.50-1.00]) and death (aHR 0.39 [0.29-0.52]) vs RT-alone. We observed exemplary outcomes for two large-scale trans-Atlantic HPV+ OPC cohorts treated in a similar manner. Concurrent chemotherapy was a strong, independent prognostic factor for all endpoints. Our findings underscore the need for a very careful approach to de-intensification of treatment for this disease.
我们比较了两个大型同期治疗的 HPV 阳性（HPV+）口咽癌（OPC）队列的结果，这些队列分别接受了根治性放疗/放化疗（RT/CRT）治疗。在 PMH 和 DAHANCA 分别鉴定了 HPV+ OPC 患者，这些患者在 2007 年至 2015 年间经 p16 确认接受了治疗。比较了局部区域失败（LRF）、远处转移（DM）和总生存（OS）。多变量分析（MVA）计算了调整后的风险比（aHR）及其 95%置信区间（95%CI），并根据队列、年龄、性别、表现状态、吸烟包年数、T 期和 N 期以及化疗进行了调整。与 PMH（n=701）相比，DAHANCA（n=1174）的 TNM-8T 分期较低（T1-T2：77% vs 56%），N 分期较低（N0-N1：77% vs 67%），分期较低（I 期：63% vs 44%，均 P<.001）。PMH 中有 69%（481）的患者接受标准分割 CRT，而 31%（220）的患者接受低分割或适度加速的单纯 RT。所有 DAHANCA 患者均接受适度加速 RT；96%（1129）的患者接受尼莫佐嗪（NIM），73%（856）的患者接受每周顺铂同步治疗。DAHANCA 的总治疗时间更短（P<.001），肿瘤总剂量（66-68 与 70Gy）和选择性颈部剂量（50 与 56Gy）更低。中位随访时间为 4.8 年。DAHANCA 患者 5 年 LRF 更高（13% vs 7%，aHR=0.47[0.34-0.67]），DM 相似（7% vs 12%，aHR=1.32[0.95-1.82]），但 OS 更好（85% vs 80%，aHR=1.30[1.01-1.68]）。CRT 患者 LRF（aHR 0.56[0.39-0.82]）、DM（aHR 0.70[0.50-1.00]）和死亡（aHR 0.39[0.29-0.52]）的风险降低。我们观察到两个大型跨大西洋 HPV+ OPC 队列接受相似治疗的出色结果。同期化疗是所有终点的强烈独立预后因素。我们的研究结果强调需要对这种疾病的治疗强度进行非常谨慎的方法。
