Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China.
Radiother Oncol. 2022 Jul;172:83-90. doi: 10.1016/j.radonc.2022.05.009. Epub 2022 May 12.
Pathological T1-2N1 oral cavity squamous cell carcinoma (pT1-2N1 OCSCC) is a setting with intermediate prognosis whilst without consensus regarding the utilization of postoperative radiotherapy (PORT). This study aimed to investigate the prognostic value of lymph node ratio (LNR) and to further examine its clinical validity for guiding PORT in pT1-2N1 OCSCC.
OCSCC patients who received surgery between 2010 and 2015 with at least 6 lymph nodes dissection were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Time-dependent receiver operating characteristic (ROC) analysis was used to identify the optimal cutoff of LNR. Multivariable Cox regression analysis was employed to assess the prognostic value of LNR. Impact of PORT was evaluated in respective subgroups stratified by LNR.
A total of 870 OCSCC patients with pT1-2N1 diseases were eligible for analysis. The 5-year overall survival (OS) and disease-specific survival (DSS) was 57.2% and 67.9% respectively. Time-dependent ROC analyses for OS and DSS concordantly revealed 5.5% as the optimal cutoff of LNR. Significantly higher risks of death (HR = 1.610, 95% CI: 1.139-2.276) and disease-specific death (HR = 1.731, 95% CI: 1.101-2.723) were unveiled in patients with LNR > 5.5%. PORT related improvement on OS (5-year rate: 57.6% vs. 47.3%, p = 0.095) and DSS (5-year rate: 71.0% vs. 53.8%, p = 0.030) was only found in LNR > 5.5% subgroup.
LNR > 5.5% is indicative of inferior outcome in pT1-2N1 OCSCC, warranting the utilization of PORT in this sub-setting.
病理 T1-2N1 口腔鳞状细胞癌（pT1-2N1 OCSCC）的预后处于中间水平，对于是否需要术后放疗（PORT）尚无共识。本研究旨在探讨淋巴结比率（LNR）的预后价值，并进一步研究其在指导 pT1-2N1 OCSCC 患者 PORT 中的临床应用价值。
从监测、流行病学和最终结果（SEER）数据库中提取 2010 年至 2015 年期间接受手术且至少清扫 6 枚淋巴结的 OCSCC 患者。采用时间依赖性接受者操作特征（ROC）分析确定 LNR 的最佳截断值。采用多变量 Cox 回归分析评估 LNR 的预后价值。根据 LNR 分层，评估 PORT 的影响。
共有 870 例 pT1-2N1 疾病的 OCSCC 患者符合分析条件。5 年总生存率（OS）和疾病特异性生存率（DSS）分别为 57.2%和 67.9%。OS 和 DSS 的时间依赖性 ROC 分析均显示 5.5%为 LNR 的最佳截断值。LNR>5.5%的患者死亡风险（HR=1.610，95%CI：1.139-2.276）和疾病特异性死亡风险（HR=1.731，95%CI：1.101-2.723）显著升高。仅在 LNR>5.5%的亚组中，PORT 可改善 OS（5 年生存率：57.6% vs. 47.3%，p=0.095）和 DSS（5 年生存率：71.0% vs. 53.8%，p=0.030）。
LNR>5.5%提示 pT1-2N1 OCSCC 患者预后较差，该亚组需要进行 PORT。
