Prognosis and Phenotypes of Advanced Head and Neck Carcinoma Associated With Hypercalcemia

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-03-11 DOI:10.1002/hed.28126

Elodie Mamou, Paul Gougis, Baptiste Abbar, Jean-philippe Spano, Laetitia Morardet, Aurore Vozy

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引用次数: 0

Abstract

Purpose

Hypercalcemia is the most common metabolic disorder in cancer, affecting 10%–20% of patients with advanced malignancies, including squamous cell carcinoma of the head and neck (HNSCC), though its prognostic significance remains poorly studied. This study aimed to evaluate the prognostic impact of hypercalcemia at diagnosis in patients with locally advanced or metastatic HNSCC and to explore underlying mechanisms and treatment options.

Methods

We conducted a bicentric, retrospective analysis of patients diagnosed between 2015 and 2021, including those with locally advanced or metastatic HNSCC undergoing chemotherapy. Hypercalcemia at diagnosis was defined as an albumin-corrected serum calcium level > 2.6 mmol/L, equivalent to 10.4 mg/dL. The primary outcome was overall survival (OS), compared between hypercalcemic and non-hypercalcemic patients using multivariate analysis. Progression-free survival (PFS), along with clinical, biological, and therapeutic characteristics were also evaluated.

Results

The study included 286 HNSCC patients, 225 (78.7%) of whom were male. Hypercalcemia incidence was 17.8%. The median OS for the cohort was 7.9 months (95% CI = 6.8–10.6). Hypercalcemic patients had a median OS of 5.9 months (95% CI = 3.8–7.9), compared to 9.1 months (95% CI = 7.3–11.7) in non-hypercalcemic patients (p = 0.002). In multivariate analysis, hypercalcemia was associated with worse OS (HR = 1.73, 95% CI = 1.17–2.56, p = 0.006). Median PFS was 4.3 months (95% CI = 3.6–5.5) for all patients. Hypercalcemic patients had a significantly shorter PFS of 2.4 months (95% CI = 1.9–4.8) compared to 4.7 months (95% CI = 3.8–5.9) in non-hypercalcemic patients (p = 0.0025). Multivariate analysis identified hypercalcemia and oral cavity tumors as negative prognostic factors, with HRs of 1.76 and 1.86, respectively. Bone metastasis rates were similar (17.6% vs. 16.2%), but local osteolysis was significantly higher in hypercalcemic patients (54.1% vs. 27.2%, p = 0.003). Bisphosphonates were administered to 38% of hypercalcemic patients.

Conclusion

In this study, hypercalcemia was an independent negative prognostic factor of survival and rapid progression in patients with locally advanced or metastatic HNSCC.

Abstract Image

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晚期头颈癌伴高钙血症的预后和表型。

目的：高钙血症是癌症中最常见的代谢紊乱，影响10%-20%的晚期恶性肿瘤患者，包括头颈部鳞状细胞癌（HNSCC），尽管其预后意义尚不清楚。本研究旨在评估局部晚期或转移性HNSCC患者诊断时高钙血症对预后的影响，并探讨潜在的机制和治疗方案。方法：我们对2015年至2021年间诊断的患者进行了双中心回顾性分析，包括接受化疗的局部晚期或转移性HNSCC患者。诊断时的高钙血症定义为白蛋白校正的血钙水平> 2.6 mmol/L，相当于10.4 mg/dL。主要终点是总生存期（OS），通过多变量分析比较高钙血症和非高钙血症患者。无进展生存期（PFS）以及临床、生物学和治疗特性也进行了评估。结果：本研究纳入286例HNSCC患者，其中男性225例（78.7%）。高钙血症发生率为17.8%。该队列的中位OS为7.9个月（95% CI = 6.8-10.6）。高钙血症患者的中位OS为5.9个月（95% CI = 3.8-7.9），而非高钙血症患者的中位OS为9.1个月（95% CI = 7.3-11.7）（p = 0.002）。在多变量分析中，高钙血症与较差的OS相关（HR = 1.73, 95% CI = 1.17-2.56, p = 0.006）。所有患者的中位PFS为4.3个月（95% CI = 3.6-5.5）。高钙血症患者的PFS显著缩短为2.4个月（95% CI = 1.9-4.8），而非高钙血症患者的PFS为4.7个月（95% CI = 3.8-5.9）（p = 0.0025）。多因素分析发现，高钙血症和口腔肿瘤是不良预后因素，其hr分别为1.76和1.86。骨转移率相似（17.6%比16.2%），但高钙血症患者的局部骨溶解率明显更高（54.1%比27.2%,p = 0.003）。38%的高钙血症患者服用双膦酸盐。结论：在这项研究中，高钙血症是局部晚期或转移性HNSCC患者生存和快速进展的独立负面预后因素。

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

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.