病理原发性肿瘤状态而非辅助治疗可预测pT1-3N1M0口腔鳞状细胞癌的生存结局：一项全国性队列研究

Pathological primary tumor status, rather than adjuvant therapy, predicts survival outcomes in pT1-3N1M0 oral cavity squamous cell carcinoma: A nationwide cohort study.

作者信息

Tsai Yao-Te, Wen Yu-Wen, Tsai Tsung-You, Lin Chien-Yu, Ng Shu-Hang, Ku Hsiu-Ying, Lou Pei-Jen, Wang Cheng Ping, Lin Jin-Ching, Hua Chun-Hung, Lee Shu-Ru, Fan Kang-Hsing, Chen Wen-Cheng, Lee Li-Yu, Chien Chih-Yen, Chen Tsung-Ming, Terng Shyuang-Der, Tsai Chi-Ying, Wang Hung-Ming, Hsieh Chia-Hsun, Yeh Chih-Hua, Lin Chih-Hung, Tsao Chung-Kan, Cheng Nai-Ming, Kang Chung-Jan, Fang Tuan-Jen, Huang Shiang-Fu, Lee Li-Ang, Fang Ku-Hao, Wang Yu-Chien, Lin Wan-Ni, Hsin Li-Jen, Yen Tzu-Chen, Liao Chun-Ta

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.

Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan, ROC; Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.

出版信息

Oral Oncol. 2025 May;164:107289. doi: 10.1016/j.oraloncology.2025.107289. Epub 2025 Apr 3.

DOI:10.1016/j.oraloncology.2025.107289

PMID:40184884

Abstract

BACKGROUND

Theeighth edition oftheAmerican Joint Committee onCancer (AJCC) Staging Manualclassifies pT1-3N1M0 oralcavity squamous cellcarcinoma (OCSCC) asp-Stage III. However, the prognosis within this group is heterogeneous, and the clinical benefit of adjuvant therapy for patients with a single nodal metastasis remains unclear.Here, we analyzed nationwide data from Taiwan to assess survival outcomes and examine the role of adjuvant therapy in this population.

METHODS

A retrospective analysis of 1324 pT1-3N1M0 OCSCC patients who underwent surgical resection between 2011 and 2021 was conducted using data from the Taiwan Cancer Registry and National Health Insurance Research Database. Cox proportional hazards models were applied to identify independent prognostic factors for disease-specific survival (DSS) and overall survival (OS).

RESULTS

Among the cohort, 247 patients (18.7 %) had pT1N1, 699 (52.8 %) had pT2N1, and 378 (28.5 %) had pT3N1 disease. The 5-year DSS rates for pT1N1, pT2N1, and pT3N1 were 82 %, 79 %, and 69 %, respectively, while OS rates were 73 %, 70 %, and 60 % (both p < 0.0001). No significant differences in DSS or OS were observed between surgery alone and adjuvant therapy. In multivariable analysis, pT3N1 disease was independently associated with worse survival outcomes (HR: 1.76,p = 0.0011 for DSS; HR: 1.63,p = 0.0005 for OS), whereas adjuvant therapies were not independent prognostic factors.

CONCLUSION

Among patients with pT1-3N1M0 OCSCC, those presenting with pT3N1 disease demonstrated significantly poorer DSS and OS. Notably, in patients lacking additional adverse pathological features, the omission of adjuvant therapy did not adversely impact survival endpoints.

摘要

背景

美国癌症联合委员会（AJCC）第八版分期手册将pT1-3N1M0口腔鳞状细胞癌（OCSCC）归类为p-Ⅲ期。然而，该组患者的预后存在异质性，对于有单个淋巴结转移的患者，辅助治疗的临床益处仍不明确。在此，我们分析了来自台湾的全国性数据，以评估生存结果并探讨辅助治疗在该人群中的作用。

方法

利用台湾癌症登记处和国民健康保险研究数据库的数据，对2011年至2021年间接受手术切除的1324例pT1-3N1M0 OCSCC患者进行回顾性分析。应用Cox比例风险模型确定疾病特异性生存（DSS）和总生存（OS）的独立预后因素。

结果

在该队列中，247例（18.7%）为pT1N1，699例（52.8%）为pT2N1，378例（28.5%）为pT3N1疾病。pT1N1、pT2N1和pT3N1的5年DSS率分别为82%、79%和69%，而OS率分别为73%、70%和60%（p均<0.0001）。单纯手术与辅助治疗之间在DSS或OS方面未观察到显著差异。在多变量分析中，pT3N1疾病与较差的生存结果独立相关（DSS的HR：1.76，p = 0.0011；OS的HR：1.63，p = 0.0005），而辅助治疗不是独立的预后因素。