Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre/University of Toronto, Canada; Department of Neuroradiology and Head & Neck Imaging, King Fahad Medical City, Riyadh, Saudi Arabia.
Department of Biostatistics, the Princess Margaret Cancer Centre/University of Toronto, Canada.
Oral Oncol. 2024 Nov;158:107007. doi: 10.1016/j.oraloncology.2024.107007. Epub 2024 Aug 21.
Clinical extranodal extension (cENE) is a cN modifier in TNM-8 for laryngo-hypopharygeal carcinoma (LHC). We hypothesize that image-detected ENE (iENE) can provide additional prognostic value over cENE in LHC.
Baseline CTs/MRIs of cN+ LHC patients treated with definitive (chemo-)radiotherapy between 2010-2019 were re-reviewed by a neuroradiologist using internationally accepted criteria for iENE-positive/negative (iENE+/iENE-). Overall survival (OS) was compared by iENE status. Multivariable analysis (MVA) was performed to confirm the prognostic value of iENE, adjusted for known potential confounders.
A total of 232 LHC patients were identified, including 154 iENE-/cENE-, 60 iENE+/cENE-, and 18 iENE+/cENE+. A higher proportion of iENE+ (vs iENE-) patients had lymph node (LN) size > 3 cm [53 (67 %) vs 4 (3 %)], >=5 LNs [51 (65 %) vs 33 (21 %)], and retropharyngeal LN [12 (15 %) vs 6 (4 %)] (all p < 0.01). Median follow-up was 4.8 years. iENE+/cENE- and iENE+/cENE+patients had similarly low 5-year OS [28 % (18-44) and 29 % (13-63)] vs iENE-/cENE- [53 % (45-62)] (p < 0.001). On MVA, mortality risk was higher with iENE+vs iENE- [hazard ratio (HR) 2.22 (95 % CI 1.47-3.36)]. The prognostic value of iENE remained with MVA in larynx (n = 124) (HR 2.51 [1.35-4.68], p = 0.004] or hypopharynx (n = 108) (HR 1.87 [1.02-3.43], p = 0.04) patients, separately.
Our study confirms the independent prognostic importance of iENE for LHC following definitive (chemo-)radiotherapy beyond TNM-8 cN status that already contains the cENE parameter. Further research is needed to explore whether iENE could replace cENE for future cN classification.
临床结外侵犯（cENE）是 TNM-8 用于喉咽癌（LHC）的 cN 修饰因子。我们假设，影像学检测到的 ENE（iENE）在 LHC 中可以提供比 cENE 更多的预后价值。
对 2010 年至 2019 年间接受确定性（放化疗）治疗的 cN+ LHC 患者的基线 CT/MRI 进行了重新回顾，由神经放射科医生使用国际公认的 iENE 阳性/阴性（iENE+/iENE-）标准进行评估。通过 iENE 状态比较总生存率（OS）。进行多变量分析（MVA），以确认 iENE 的预后价值，并对已知的潜在混杂因素进行调整。
共确定了 232 例 LHC 患者，包括 154 例 iENE-/cENE-、60 例 iENE+/cENE-和 18 例 iENE+/cENE+。与 iENE-（vs iENE+）患者相比，更多的 iENE+患者的淋巴结（LN）大小>3cm [53（67%）vs 4（3%）]、>=5 个 LN [51（65%）vs 33（21%）]和咽后 LN [12（15%）vs 6（4%）]（均 p<0.01）。中位随访时间为 4.8 年。iENE+/cENE-和 iENE+/cENE+患者的 5 年 OS 均较低[28%（18-44）和 29%（13-63）]，而 iENE-/cENE-为 53%（45-62）（p<0.001）。多变量分析显示，与 iENE-相比，iENE+患者的死亡率更高[风险比（HR）2.22（95%可信区间 1.47-3.36）]。在对包括 124 例喉癌（n=124）（HR 2.51[1.35-4.68]，p=0.004]和 108 例下咽癌（n=108）（HR 1.87[1.02-3.43]，p=0.04）患者进行多变量分析后，iENE 的预后价值仍然存在。
我们的研究证实，在包含 cENE 参数的 TNM-8 cN 状态之外，iENE 对 LHC 患者接受确定性（放化疗）后的独立预后具有重要意义。需要进一步研究来探讨 iENE 是否可以替代 cENE 用于未来的 cN 分类。
