The prognostic value of image-identified extranodal extension in laryngeal and hypopharyngeal carcinoma following definitive (chemo-)radiotherapy

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2024-08-21 DOI:10.1016/j.oraloncology.2024.107007

Sulaiman Alsheikh , Jie Su , Brian O’Sullivan , Jolie Ringash , John N Waldron , Scott V Bratman , John Cho , Enrique Sanz Garcia , Anna Spreafico , John de Almeida , Ezra Hahn , Andrew Hope , Ali Hosni , John Kim , Andrew McPartlin , Jillian Tsai , Tong Li , Wei Xu , Eugene Yu , Shao Hui Huang

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引用次数: 0

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

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喉癌和下咽癌接受确定性（化疗）放疗后，影像识别的结节外扩展的预后价值

目的临床结节外扩展（cENE）是喉-上咽癌（LHC）TNM-8 中的一个 cN 修饰符。我们假设，图像检测到的ENE（iENE）能为LHC患者提供比cENE更多的预后价值。方法神经放射科医生采用国际公认的iENE阳性/阴性（iENE+/iENE-）标准，对2010-2019年间接受确定性（化疗）放疗的cN+ LHC患者的基线CT/MRI进行重新审查。根据 iENE 状态比较总生存期（OS）。在对已知的潜在混杂因素进行调整后，进行了多变量分析（MVA）以确认iENE的预后价值。结果共发现232例LHC患者，其中包括154例iENE-/cENE-、60例iENE+/cENE-和18例iENE+/cENE+。iENE+（vs iENE-）患者淋巴结（LN）大小为3厘米[53 (67 %) vs 4 (3 %)]、LN为5个[51 (65 %) vs 33 (21 %)]和咽后LN为5个[12 (15 %) vs 6 (4 %)]的比例更高（所有P均为0.01）。iENE+/cENE-和iENE+/cENE+患者的5年OS[28% (18-44)和29% (13-63)]与iENE-/cENE-[53% (45-62)]相比同样较低 (p <0.001)。在 MVA 中，iENE+vs iENE- 的死亡风险更高[危险比 (HR) 2.22 (95 % CI 1.47-3.36)]。在喉部（n = 124）（HR 2.51 [1.35-4.68]，p = 0.004）或下咽（n = 108）（HR 1.87 [1.02-3.43]，p = 0.04）患者中，iENE 的预后价值仍与 MVA 无关。还需要进一步研究探讨 iENE 是否可以取代 cENE 用于未来的 cN 分类。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.