Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
Radiother Oncol. 2023 Sep;186:109771. doi: 10.1016/j.radonc.2023.109771. Epub 2023 Jun 28.
Distant metastases (DM) in head and neck squamous cell carcinomas (HNSCC) are in most circumstances non-curable. The TNM staging system is insufficient to predict the risk of DM. This study investigates if the DM risk can be predicted using a multivariate model including pre-treatment total tumor volume for both p16-positive oropharyngeal squamous cell carcinoma (OPSCC) and all other sites (other HNSCC).
The study includes patients with localized pharyngeal and laryngeal squamous cell carcinomas treated with primary radiotherapy from 2008-2017 from three head and neck cancer centers. Patients were identified in the Danish Head and Neck Cancer (DAHANCA) database. Total (nodal and primary) tumor volume (Gross Tumor Volume, GTV) was extracted from local treatment planning systems. The GTV was grouped by volume (cm) in four intervals and included in a multivariate Cox proportional hazard regression controlled for pre-selected clinical values incl. stage.
The study includes 2,865 patients, of which 321 (11 %) had DM post-treatment. The risk of DM was assessed in a multivariate model based on 2,751 patients (p16-positive OPSCC: 1,032; and other HNSCC: 1,719). There was a significant association between GTV and the risk of DM, and in tumor volumes ≥ 50 cm hazard ratios of 7.6 (2.5-23.4) for p16-positive OPSCC and 4.1 (2.3-7.2) in other HNSCC were observed.
Tumor volume is an independent risk factor for DM. The addition of total tumor volume to a predictive model is important to identify subgroups of HNSCC patients at high risk of DM.
头颈部鳞状细胞癌（HNSCC）的远处转移（DM）在大多数情况下是无法治愈的。TNM 分期系统不足以预测 DM 的风险。本研究探讨了是否可以使用包括 p16 阳性口咽鳞状细胞癌（OPSCC）和所有其他部位（其他 HNSCC）的治疗前总肿瘤体积的多变量模型来预测 DM 风险。
本研究纳入了 2008 年至 2017 年期间在三个头颈癌中心接受原发放疗的局限性咽和喉鳞状细胞癌患者。患者从丹麦头颈癌（DAHANCA）数据库中确定。从局部治疗计划系统中提取总（淋巴结和原发）肿瘤体积（Gross Tumor Volume，GTV）。GTV 按体积（cm）分为四组，并包含在多变量 Cox 比例风险回归中，该回归控制了包括分期在内的预先选择的临床值。
本研究纳入了 2865 名患者，其中 321 名（11%）在治疗后发生 DM。在基于 2751 名患者的多变量模型中评估了 DM 的风险（p16 阳性 OPSCC：1032 例；其他 HNSCC：1719 例）。GTV 与 DM 风险之间存在显著关联，在肿瘤体积≥50cm3时，p16 阳性 OPSCC 的危险比为 7.6（2.5-23.4），其他 HNSCC 为 4.1（2.3-7.2）。
肿瘤体积是 DM 的独立危险因素。将总肿瘤体积添加到预测模型中对于识别 HNSCC 患者中 DM 风险较高的亚组非常重要。
