Radiotherapy Department, Donostia University Hospital, San Sebastian, Spain.
Medical University of Bialystok, Bialystok, Poland.
Cancer Rep (Hoboken). 2023 Dec;6(12):e1897. doi: 10.1002/cnr2.1897. Epub 2023 Sep 12.
Tumor deposits (TDs) are an infrequently mentioned feature of head and neck squamous cell carcinoma (HNSCC) that are currently grouped under extranodal extension (ENE) in the AJCC 8th edition of HNSCC TNM staging. The prognostic implication of TDs in comparison to ENE remains uncertain.
This observational, retrospective, non-randomized study evaluated patients with HNSCC who underwent initial surgical resection, with neck dissection and adjuvant radiotherapy ± chemotherapy. Clinical variables were considered, and statistical analyses were conducted to compare time progression and overall survival (OS) in patients with TDs against those with ENE.
Of the 71 patients included in the study, 50 were diagnosed with ENE (pN2a-ENE in 38 patients and pN3b-ENE in 12), while 21 had TDs ± ENE. The median time to progression was significantly different based on the presence of ENE or TDs (p = .002) and pN2a-ENE/pN3b-ENE or TDs (p = .007). The three-year OS was 55.7% for the entire group, 60.4% in ENE and 38.4% in TDs (p = .021). The OS difference between the pN2a-ENE, pN3b-ENE, and the TDs group was also significant (p = .05). The hazard ratio between ENE and TDs was Exp (B) 4.341 (p = .044).
TDs in HNSCC are associated with a lower OS than ENE, despite intensified adjuvant therapy. Our results confirm a better prognosis for pN2a-ENE vs. pN3b-ENE, and pN3b-ENE vs. TDs. TDs may serve as an indicator of poor prognosis and require separate TNM classification in HNSCC staging. Larger studies are needed to evaluate TDs impact on treatment strategies and outcomes.
肿瘤沉积（TDs）是头颈部鳞状细胞癌（HNSCC）中一个很少被提及的特征，目前在第 8 版 AJCC HNSCC TNM 分期中被归类为结外扩展（ENE）。TDs 与 ENE 相比的预后意义仍不确定。
本观察性、回顾性、非随机研究评估了接受初始手术切除、颈清扫术和辅助放化疗的 HNSCC 患者。考虑了临床变量，并进行了统计分析，以比较 TDs 患者与 ENE 患者的时间进展和总生存期（OS）。
在纳入研究的 71 名患者中，50 名被诊断为 ENE（38 名患者为 pN2a-ENE，12 名患者为 pN3b-ENE），而 21 名患者存在 TDs±ENE。基于 ENE 或 TDs 的存在，进展时间存在显著差异（p=0.002）和 pN2a-ENE/pN3b-ENE 或 TDs（p=0.007）。整个组的三年 OS 为 55.7%，ENE 为 60.4%，TDs 为 38.4%（p=0.021）。pN2a-ENE、pN3b-ENE 和 TDs 组之间的 OS 差异也具有统计学意义（p=0.05）。ENE 和 TDs 之间的危险比为 Exp（B）4.341（p=0.044）。
尽管接受了强化辅助治疗，HNSCC 中的 TDs 与较低的 OS 相关。我们的结果证实，pN2a-ENE 比 pN3b-ENE，pN3b-ENE 比 TDs 的预后更好。TDs 可能是预后不良的指标，需要在 HNSCC 分期中进行单独的 TNM 分类。需要更大规模的研究来评估 TDs 对治疗策略和结果的影响。
