University of Kentucky, College of Medicine, Lexington, Kentucky, USA.
University of Kentucky, Department of Otolaryngology-Head and Neck Surgery, Lexington, Kentucky, USA.
Laryngoscope. 2023 Oct;133(10):2621-2626. doi: 10.1002/lary.30572. Epub 2023 Jan 19.
The American Joint Committee on Cancer's 8th edition (AJCC-8) separates oropharyngeal squamous cell carcinomas (OPSCCs) into human papillomavirus-positive (HPV+) tumors and HPV-negative tumors. Although AJCC-8 improves prognostic prediction for survival for the majority of HPV+ OPSCC, outliers are still encountered. The goal of this manuscript is to validate the AJCC-8 as a better metric of survivability than the AJCC-7 in an historically under-served rural population with confounding variables, such as tobacco use, alcohol consumption, and poor health care access and to analyze the role of extranodal extension (ENE) in this population.
Retrospective cohort study.
Compared to AJCC-7, AJCC-8 had a higher odds ratio (OR) for predicting mortality of stage IV HPV+ OPSCCs versus stages I-III. On multivariate analysis, HPV+ OPSCCs with ENE had a higher OR of mortality compared to ENE- OPSCCs. In addition, HPV+ OPSCC patients with a Charlson Comorbidity Index (CCI) > 3 had a higher OR of mortality compared to those with a CCI ≤ 3. Patients with Medicaid/self-pay status had a higher OR of mortality compared to those with private insurance/Medicare. Finally, patients from rural populations had a higher OR of presenting with stage IV disease, a CCI > 3, and Medicaid/self-pay status.
Despite not being a discrete part of the AJCC-8 staging rubric, ENE was found to have a significant impact on mortality among this population, whereas tobacco use had no effect. Rural patients were more likely to present with stage IV disease, CCI > 3, and Medicaid/self-pay status. Stage IV disease was also associated with a higher OR of mortality.
4 Laryngoscope, 133:2621-2626, 2023.
美国癌症联合委员会第 8 版（AJCC-8）将口咽鳞状细胞癌（OPSCC）分为人乳头瘤病毒阳性（HPV+）肿瘤和 HPV 阴性肿瘤。尽管 AJCC-8 提高了大多数 HPV+OPSCC 患者的生存预后预测能力，但仍存在异常值。本文的目的是验证 AJCC-8 作为一种比 AJCC-7 更好的生存率衡量标准，特别是在存在混杂变量（如烟草使用、酒精消费、以及医疗保健获取不足）的历史上服务不足的农村人群中，并分析该人群中淋巴结外扩展（ENE）的作用。
回顾性队列研究。
与 AJCC-7 相比，AJCC-8 对预测 IV 期 HPV+OPSCC 与 I-III 期相比的死亡率有更高的比值比（OR）。在多变量分析中，与无 ENE 的 OPSCC 相比，有 ENE 的 HPV+OPSCC 具有更高的死亡率比值比（OR）。此外，与 CCI≤3 的患者相比，CCI>3 的 HPV+OPSCC 患者的死亡率比值比（OR）更高。具有医疗补助/自付身份的患者与具有私人保险/医疗保险的患者相比，死亡率比值比（OR）更高。最后，农村人口的患者更有可能出现 IV 期疾病、CCI>3 和医疗补助/自付身份。
尽管 ENE 不是 AJCC-8 分期准则的一个独立部分，但在该人群中发现它对死亡率有显著影响，而烟草使用则没有影响。农村患者更有可能出现 IV 期疾病、CCI>3 和医疗补助/自付身份。IV 期疾病也与更高的死亡率比值比（OR）相关。
4 级。喉镜，133：2621-2626，2023。
