Meulemans Jeroen, Werpin Louis, Hermans Robert, Laenen Annouschka, Nuyts Sandra, Clement Paul M, Delaere Pierre, Van Lierde Charlotte, Vander Poorten Vincent
Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
Eur Arch Otorhinolaryngol. 2024 Mar;281(3):1541-1558. doi: 10.1007/s00405-023-08409-8. Epub 2024 Jan 3.
Radiological extranodal extension (rENE) is a well-known negative prognosticator in head and neck squamous cell carcinoma (HNSCC). However, controversy remains regarding the prognostic effect of rENE in HPV-positive oropharyngeal SCCs (OPSCC). This single-center retrospective cohort analysis assessed the prognostic role of rENE in an HPV + OPSCC population and tried to validate a recently proposed modification of the TNM8 N-classification.
129 patients with HPV + OPSCC, of whom 106 cN + patients, were included. Radiological imaging (CT, MRI or both) was reanalyzed by a senior head and neck radiologist. Overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRFS), and disease-specific survival (DSS) were evaluated. Cox proportional hazard models were used for estimating hazard ratios (HR).
A non-significant trend towards better outcomes in the rENE- group, as compared to the rENE + population, was observed for 5 year OS [80.99% vs 68.70%, HR: 2.05, p = 0.160], 5 year RFS [78.81% vs 67.87%, HR: 1.91, p = 0.165], 5 year DFS [77.06% vs 60.16%, HR: 2.12, p = 0.0824] and 5 year DSS [88.83% vs 81.93%, HR: 2.09, p = 0.195]. OS declined with ascending levels of rENE (p = 0.020). Multivariate analysis identified cT-classification and smoking as independent negative predictors for OS/DFS. The proposed modification of the TNM8 N-classification could not be validated.
Although rENE could not be identified as an independent negative prognosticator for outcome in our HPV + OPSCC population, outcomes tend to deteriorate with increasing rENE.
放射学上的结外侵犯（rENE）是头颈部鳞状细胞癌（HNSCC）中一个众所周知的不良预后因素。然而，rENE在人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）中的预后影响仍存在争议。这项单中心回顾性队列分析评估了rENE在HPV+OPSCC人群中的预后作用，并试图验证最近提出的TNM8 N分期的修订版。
纳入129例HPV+OPSCC患者，其中106例为cN+患者。由一位资深头颈放射科医生重新分析放射学影像（CT、MRI或两者）。评估总生存期（OS）、无病生存期（DFS）、局部区域无复发生存期（LRFS）和疾病特异性生存期（DSS）。采用Cox比例风险模型估计风险比（HR）。
与rENE+人群相比，rENE-组在5年OS[80.99%对68.70%，HR：2.05，p=0.160]、5年RFS[78.81%对67.87%，HR：1.91，p=0.165]、5年DFS[77.06%对60.16%，HR：2.12，p=0.0824]和5年DSS[88.83%对81.93%，HR：2.09，p=0.195]方面观察到有更好结局的非显著趋势。OS随着rENE水平的升高而下降（p=0.020）。多变量分析确定cT分期和吸烟为OS/DFS的独立阴性预测因素。TNM8 N分期的提议修订版未得到验证。
虽然在我们的HPV+OPSCC人群中，rENE不能被确定为结局的独立不良预后因素，但随着rENE增加，结局往往会恶化。
