Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
Oncologist. 2022 Feb 3;27(1):4-6. doi: 10.1093/oncolo/oyab010.
This commentary highlights three important findings in the study by Vijayvargiya et al, published in this journal, involving 9554 oropharyngeal cancer patients from the SEER database. Firstly, there is improved performance in outcome prediction with TNM-8 in HPV+ OPC. However, heterogeneity exists, especially in TNM-8 stage I disease, and there is need for ongoing improvement in risk stratification. Several anatomical and non-anatomical prognostic factors have been proposed. Among them, radiologic extranodal extension has emerged as one of the promising parameters to be considered for future staging. These baseline prognostic factors should address sensitivity, specificity, and diagnostic accuracy to serve different clinical needs. Secondly, cure is possible for some patients presenting with M1 disease. Optimal management of such patients remains to be explored, and clinical trials targeting de novo M1 disease should be encouraged to optimize outcomes for this subset. Finally, methodologies to address missing tumor HPV status in historical cohorts have been discussed, including using baseline demographics and clinical characteristics, as well as statistical procedures such as multiple imputation.
本评论重点介绍了 Vijayvargiya 等人在本杂志上发表的一项研究中的三项重要发现，该研究涉及来自 SEER 数据库的 9554 例口咽癌患者。首先，在 HPV+ OPC 中，TNM-8 对预后的预测性能有所提高。然而，存在异质性，特别是在 TNM-8 期疾病中，需要不断改进风险分层。已经提出了几种解剖学和非解剖学预后因素。其中，影像学结外侵犯已成为未来分期中值得考虑的有前途的参数之一。这些基线预后因素应解决敏感性、特异性和诊断准确性，以满足不同的临床需求。其次，对于一些表现为 M1 疾病的患者，治愈是可能的。对于这类患者的最佳治疗方法仍有待探索，应鼓励针对新发 M1 疾病的临床试验，以优化这部分患者的治疗效果。最后，讨论了在历史队列中解决肿瘤 HPV 状态缺失的方法，包括使用基线人口统计学和临床特征，以及多重插补等统计程序。
