喉鳞状细胞癌的结外扩展
Extranodal extension in laryngeal squamous cell carcinoma.
作者信息
Patel Aman M, Vedula Sudeepti, Shaari Ariana L, Choudhry Hannaan S, Filimonov Andrey
机构信息
Department of Otolaryngology-Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA.
出版信息
Laryngoscope Investig Otolaryngol. 2024 Mar 25;9(2):e1232. doi: 10.1002/lio2.1232. eCollection 2024 Apr.
OBJECTIVE
Although large retrospective database studies have associated extranodal extension (ENE) with worse survival in several head and neck cancers, the prognostic significance of ENE in laryngeal squamous cell carcinoma (LSCC) remains unclear. Our study examines ENE and overall survival (OS) in LSCC.
METHODS
The 2006-2017 National Cancer Database was queried for patients with LSCC undergoing surgical resection and neck dissection, with or without adjuvant therapy. Kaplan-Meier and multivariable Cox regression survival analyses were implemented to identify the independent impacts of pathologic nodal (pN) classification and ENE on OS.
RESULTS
Of 4208 patients satisfying inclusion criteria, 2343 (55.7%) were pN0/ENE-negative, 1059 (25.2%) were pN1-2/ENE-negative, and 806 (19.2%) were pN1-2/ENE-positive. The 5-year OS of pN0/ENE-negative, pN1-2/ENE-negative, and pN1-2/ENE-positive patients was 62.8%, 56.7%, and 32.9%, respectively ( < .001). Among pN1-2/ENE-positive patients undergoing no adjuvant therapy, adjuvant radiotherapy alone, and adjuvant chemoradiotherapy, 5-year OS was 24.1%, 30.7%, and 36.7%, respectively ( < .001). After adjusting for patient demographics, clinicopathologic features, and adjuvant therapy, ENE-positivity was associated with worse OS than ENE-negativity (adjusted hazard ratio [aHR] 1.76, 95% confidence interval [CI] 1.53-2.02, < .001). pN1/ENE-positivity (aHR 1.82, 95% CI 1.31-2.54) and pN2/ENE-positivity (aHR 1.89, 95% CI 1.49-2.40) were associated with worse OS than pN1/ENE-negativity ( < .001). Microscopic (aHR 1.83, 95% CI 1.54-2.18) and macroscopic ENE-positivity (aHR 1.75, 95% 1.35-2.26) were associated with worse OS than ENE-negativity ( < .001).
CONCLUSION
ENE-positivity has prognostic significance in LSCC and is associated with worse OS than ENE-negativity. pN classification did not have prognostic significance independent of ENE. ENE should be carefully considered when determining the prognosis of LSCC and selecting adjuvant therapy.
LEVEL OF EVIDENCE
目的
尽管大型回顾性数据库研究已将结外侵犯（ENE）与多种头颈癌患者较差的生存率相关联，但ENE在喉鳞状细胞癌（LSCC）中的预后意义仍不明确。我们的研究旨在探讨LSCC中的ENE与总生存期（OS）。
方法
查询2006 - 2017年国家癌症数据库中接受手术切除及颈部清扫术的LSCC患者，无论其是否接受辅助治疗。采用Kaplan - Meier法和多变量Cox回归生存分析来确定病理淋巴结（pN）分类和ENE对OS的独立影响。
结果
在4208例符合纳入标准的患者中，2343例（55.7%）为pN0/ENE阴性，1059例（25.2%）为pN1 - 2/ENE阴性，806例（19.2%）为pN1 - 2/ENE阳性。pN0/ENE阴性、pN1 - 2/ENE阴性和pN1 - 2/ENE阳性患者的5年OS分别为62.8%、56.7%和32.9%（P <.001）。在未接受辅助治疗、仅接受辅助放疗和接受辅助放化疗的pN1 - 2/ENE阳性患者中，5年OS分别为24.1%、30.7%和36.7%（P <.001）。在调整患者人口统计学、临床病理特征和辅助治疗因素后，ENE阳性与比ENE阴性更差的OS相关（调整后风险比[aHR] 1.76，95%置信区间[CI] 1.53 - 2.02，P <.001）。pN1/ENE阳性（aHR 1.82，95% CI 1.31 - 2.54）和pN2/ENE阳性（aHR 1.89，95% CI 1.49 - 2.40）与比pN1/ENE阴性更差的OS相关（P <.0）。微观（aHR 1.83，95% CI 1.54 - 2.18）和宏观ENE阳性（aHR 1.75，95% 1.35 - 2.26）与比ENE阴性更差的OS相关（P <.001）。
结论
ENE阳性在LSCC中具有预后意义，且与比ENE阴性更差的OS相关。pN分类在不考虑ENE的情况下不具有独立的预后意义。在确定LSCC的预后和选择辅助治疗时应仔细考虑ENE。
证据级别
4级。
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