头颈部淋巴上皮瘤样癌的临床特征、预后因素和治疗方式：来自中国南方的真实世界研究。

Clinical characteristics, prognostic factors, and treatment modalities for head and neck lymphoepithelioma-like carcinoma: A real-world study from southern China.

机构信息

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, PR China.

Department of Pathology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, PR China.

出版信息

Radiother Oncol. 2023 Oct;187:109814. doi: 10.1016/j.radonc.2023.109814. Epub 2023 Jul 20.

DOI:10.1016/j.radonc.2023.109814

PMID:37480992

Abstract

BACKGROUND

We aimed to elucidate the clinical characteristics, prognostic factors and optimal treatment modalities of head and neck lymphoepithelioma-like carcinoma (HNLELC).

METHODS

Consecutive patients newly-diagnosed with non-metastatic HNLELC between December 2001 and March 2021 treated with curative intent were retrospectively reviewed.

RESULTS

A total of 288 patients were included, of whom 87 (30.2%) underwent radical surgery alone, 43 (14.9%) underwent definitive radiotherapy with or without concurrent chemotherapy, and 158 (54.9%) underwent surgery followed by postoperative radiotherapy (SRT). Epstein-Barr virus-encoded small RNA (EBER) was positive in 94.8% (239/252) of patients. Cervical node infiltration was seen in 52.8% (152/288) of patients. No significant difference was found in nodal metastasis rate between T1-2 and T3-4 classifications (49.5% vs. 56.5%, p = 0.308). The 3-year overall survival (OS), disease-free survival, locoregional relapse-free survival, and distant metastasis-free survival rates were 89.4%, 78.7%, 89.2%, and 87.7%, respectively. Compared to SRT, surgery alone associated with significant reduced 3-year local (92.8% vs. 96.5%, p = 0.012) and regional relapse-free survival rates (89.3% vs. 96.8%, p = 0.002). Definitive radiotherapy and SRT demonstrated comparable results in all 3-year survival outcomes (all p＞0.05). Multivariate analysis found EBER status was an independent favorable prognostic factor for OS (HR = 0.356, 95% CI: 0.144-0.882, p = 0.026).

CONCLUSION

HNLELC was observed to associate with EBV infection and cervical nodal infiltration. Definitive radiotherapy achieved similar survival outcomes compared to SRT, and may serve as a good substitute for patients unfit or unwilling to undergo surgery.

摘要

背景

本研究旨在阐明头颈部淋巴上皮样癌（HNLELC）的临床特征、预后因素和最佳治疗方式。

方法

回顾性分析 2001 年 12 月至 2021 年 3 月期间接受根治性治疗的新诊断为非转移性 HNLELC 的连续患者。

结果

共纳入 288 例患者，其中 87 例（30.2%）单纯接受根治性手术，43 例（14.9%）接受根治性放疗联合或不联合同期化疗，158 例（54.9%）接受手术加术后放疗（SRT）。252 例患者中 94.8%（239/252）EBER 阳性。288 例患者中 52.8%（152/288）存在颈部淋巴结浸润。T1-2 期和 T3-4 期分类的淋巴结转移率无显著差异（49.5% vs. 56.5%，p=0.308）。3 年总生存率（OS）、无病生存率、局部区域无复发生存率和远处无转移生存率分别为 89.4%、78.7%、89.2%和 87.7%。与 SRT 相比，单纯手术治疗与 3 年局部（92.8% vs. 96.5%，p=0.012）和区域无复发生存率（89.3% vs. 96.8%，p=0.002）显著降低相关。根治性放疗和 SRT 在所有 3 年生存结果中均显示出相似的结果（均 p＞0.05）。多因素分析发现 EBER 状态是 OS 的独立预后因素（HR=0.356，95%CI：0.144-0.882，p=0.026）。