口腔鳞状细胞癌伴轻微和严重淋巴结外扩展的辅助放化疗

Adjuvant Chemoradiotherapy for Oral Cavity SCC With Minor and Major Extranodal Extension.

作者信息

Manojlovic-Kolarski Mirko, Su Susie, Weinreb Ilian, Calvisi Robert, Perez-Ordonez Bayardo, Smith Stephen, Patel Snehal, Valero Cristina, Xu Bin, Ghossein Ronald, Katabi Nora, Clark Jonathan, Low Tsu-Hui Hubert, Gupta Ruta, Graboyes Evan, Davies Joel, Richardson Mary, Goldstein David, Huang Shao Hui, O'Sullivan Brian, Xu Weu, Hansen Aaron, de Almeida John R

机构信息

Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, Ontario, Canada.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada.

出版信息

JAMA Otolaryngol Head Neck Surg. 2025 Jun 18. doi: 10.1001/jamaoto.2025.1721.

DOI:10.1001/jamaoto.2025.1721

PMID:40531540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12177724/

Abstract

IMPORTANCE

Extranodal extension (ENE) in oral cavity squamous cell carcinoma (OSCC) is a poor prognostic feature and an indication for adjuvant chemoradiotherapy. ENE is stratified into minor (≤2 mm) or major (>2 mm) extent. The role of adjuvant chemoradiotherapy, particularly for the minor ENE subgroup, is unclear.

OBJECTIVE

To determine the impact of adjuvant chemoradiotherapy on oncological outcomes depending on the extent of ENE.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cohort study was conducted across 4 high-volume head and neck surgery centers in Australia, the US, and Canada. The study included patients with surgically resected OSCC with pathologic positive nodal disease treated between 2005 and 2018. Statistical analysis took place between 2022 and 2025; final follow-up was in 2022.

EXPOSURES

Extent of ENE was restaged on archived tissue. Adjuvant radiotherapy or chemoradiotherapy was recommended per standard guidelines.

OUTCOMES

Univariable and multivariable analysis were used to assess the effect of chemotherapy for the entire group and for propensity score-matched cohorts on locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) stratified by minor vs major ENE.

RESULTS

A total of 755 patients (mean [SD] age, 61.7 [12.9] years; 36% female) were included in the study: 126 (17%) with minor ENE and 243 (32%) with major ENE. A total of 50 (39.7%) patients with minor ENE and 116 (47.8%) with major ENE received adjuvant chemotherapy. On multivariable analysis, chemotherapy was not associated with improved LRC (hazard ratio [HR], 1.07 [95% CI, 0.49-2.32]), DFS (HR, 0.96 [95% CI, 0.56-1.66]), or OS (HR, 0.97 [95% CI, 0.55-1.73]) in patients with minor ENE. However, in patients with major ENE, chemotherapy improved DFS (HR, 0.58 [95% CI, 0.41-0.81]) and OS (HR, 0.61 [95% CI, 0.38-0.98]). In propensity score-matched cohorts, chemotherapy did not improve LRC (71% vs 75%; difference, 4% [95% CI, -18% to 26%]), DFS (56% vs 56%; difference, 0% [95% CI, -25% to 25%]), or OS (57% vs 57%; difference, 0% [95% CI, -25% to 25%]) for patients with minor ENE, but improved DFS (33% vs 11%; difference, 22% [95% CI, 5%-38%]) and OS (41% vs 15%; difference, 26% [95% CI, 8%-44%]) but not LRC (61% vs 62%; difference, 1% [95% CI, -17% to 21%]) in patients with major ENE.

CONCLUSIONS

This multicenter cohort study found that in patients with OSCC, adjuvant chemotherapy is beneficial in patients with major ENE, but may not be beneficial in patients with minor ENE.

摘要

重要性

口腔鳞状细胞癌（OSCC）中的结外扩展（ENE）是一个预后不良的特征，也是辅助放化疗的指征。ENE分为轻度（≤2 mm）或重度（>2 mm）扩展。辅助放化疗的作用，尤其是对轻度ENE亚组的作用尚不清楚。

目的

根据ENE的程度确定辅助放化疗对肿瘤学结局的影响。

设计、设置和参与者：这项回顾性多中心队列研究在澳大利亚、美国和加拿大的4个大型头颈外科中心进行。该研究纳入了2005年至2018年间接受手术切除且病理检查淋巴结疾病呈阳性的OSCC患者。统计分析在2022年至2025年进行；最终随访于2022年完成。

暴露因素

根据存档组织重新分期ENE的程度。根据标准指南推荐辅助放疗或放化疗。

结局

采用单变量和多变量分析评估化疗对整个组以及倾向评分匹配队列的局部区域控制（LRC）、无病生存期（DFS）和总生存期（OS）的影响，并按轻度与重度ENE进行分层。

结果

该研究共纳入755例患者（平均[标准差]年龄，61.7[12.9]岁；36%为女性）：126例（17%）为轻度ENE，243例（32%）为重度ENE。共有50例（39.7%）轻度ENE患者和116例（47.8%）重度ENE患者接受了辅助化疗。多变量分析显示，化疗与轻度ENE患者的LRC改善（风险比[HR]，1.07[95%置信区间，0.49 - 2.32]）、DFS改善（HR，0.96[95%置信区间，0.56 - 1.66]）或OS改善（HR，0.97[95%置信区间，0.55 - 1.73]）无关。然而，在重度ENE患者中，化疗改善了DFS（HR，0.58[95%置信区间，0.41 - 0.81]）和OS（HR，0.61[95%置信区间，0.38 - 0.98]）。在倾向评分匹配队列中，化疗对轻度ENE患者的LRC（71%对75%；差异，4%[95%置信区间，-18%至26%]）、DFS（56%对56%；差异，0%[95%置信区间，-25%至25%]）或OS（57%对57%；差异，0%[95%置信区间，-25%至25%]）没有改善，但对重度ENE患者的DFS（33%对11%；差异，22%[95%置信区间，5% - 38%]）和OS（41%对15%；差异，26%[95%置信区间，8% - 44%]）有改善，但对LRC没有改善（61%对62%；差异，1%[95%置信区间，-17%至21%]）。