Matsuo Mioko, Hashimoto Kazuki, Kogo Ryunosuke, Sato Masanobu, Manako Tomomi, Nakagawa Takashi
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Cancer Diagn Progn. 2024 Sep 1;4(5):658-666. doi: 10.21873/cdp.10378. eCollection 2024 Sep-Oct.
BACKGROUND/AIM: Approximately half of head and neck squamous cell carcinoma (HNSCC) cases recur, with most recurrences occurring within the first two years after treatment. Although it has been suggested that the interval to recurrence after radical treatment is associated with prognosis in patients with HNSCC, further investigation is needed.
Patients diagnosed with HNSCC at Kyushu University Hospital were retrospectively analyzed (n=500). Early recurrence (ER) was defined as disease recurrence within six months of radical treatment, whereas late recurrence (LR) was defined as recurrence after more than six months. Continuous variables were assessed using the Mann-Whitney U-test and categorical variables were assessed using Fisher's exact test.
A total of 234 patients experienced recurrence, with 110 and 124 patients experiencing ER (recurrence within two to six months) and LR (recurrence after six months), respectively. Multivariate analyses identified two independent risk factors for poor prognosis: ER [hazard ratio (HR)=3.200, 95% confidence interval (CI)=1.570-6.521, p=0.001] and absence of radiotherapy (HR=0.374, 95%CI=0.191-0.733, p=0.004). In patients with recurrent HNSCC, a short interval to recurrence is a risk factor for poor prognosis and survival. This study demonstrated the prognostic value of ER in these patients.
The selection of treatment for patients with recurrent head and neck squamous cell carcinoma should consider the timing of recurrence, the initial treatment regimen, and the strategy for changing salvage therapy depending on the recurrence status.
背景/目的：约一半的头颈部鳞状细胞癌（HNSCC）病例会复发，大多数复发发生在治疗后的头两年内。尽管有人提出根治性治疗后至复发的间隔时间与HNSCC患者的预后相关，但仍需进一步研究。
对在九州大学医院被诊断为HNSCC的患者进行回顾性分析（n = 500）。早期复发（ER）定义为根治性治疗后六个月内疾病复发，而晚期复发（LR）定义为六个月后复发。连续变量采用曼-惠特尼U检验进行评估，分类变量采用费舍尔精确检验进行评估。
共有234例患者复发，其中110例和124例患者分别经历早期复发（2至6个月内复发）和晚期复发（6个月后复发）。多因素分析确定了两个预后不良的独立危险因素：早期复发[风险比（HR）= 3.200，95%置信区间（CI）= 1.570 - 6.521，p = 0.001]和未接受放疗（HR = 0.374，95%CI = 0.191 - 0.733，p = 0.004）。在复发性HNSCC患者中，复发间隔时间短是预后不良和生存的危险因素。本研究证明了早期复发在这些患者中的预后价值。
复发性头颈部鳞状细胞癌患者的治疗选择应考虑复发时间、初始治疗方案以及根据复发情况改变挽救治疗的策略。
