{"title":"头颈癌结节外扩展的风险分层--对加强治疗的意义","authors":"Smriti Panda, Rajeev Kumar, Aanchal Kakkar, Sandipta Mitra, Vishwajeet Singh, Alok Thakar, Chirom Amit Singh, Kapil Sikka, Anup Singh, Kavneet Kaur, Aman Sharma, Akash Kumar, Amit Kumar, Rachit Sood, Karthika Chettuvatti, Areej Moideen, Nongthombam Surjalata Devi","doi":"10.1002/hed.28144","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Extranodal extension (ENE) is an important adverse prognostic indicator for head and neck cancers. However, ENE needs further risk stratification in terms of optimum cutoff for the extent of ENE and interaction with clinicopathological risk factors.</p><p><strong>Methods: </strong>Retrospective single-center study on patients with treatment-naïve head and neck cancer with final histology indicating ENE.</p><p><strong>Results: </strong>Pathological ENE was observed in 122 patients (12.4%). With the 2 mm cutoff separating Mi-ENE and Ma-ENE, no difference was observed in overall survival (OS) and disease-free survival (DFS) for unmatched (OS: 40.9% vs. 33.6%, p = 0.7; DFS: 34.05% vs. 26.12%, p = 0.5) as well as propensity score-matched cohort (OS: HR 1.08, p = 0.82; DFS: HR 0.95, p = 0.89). Receiver-operator curve (ROC) analysis showed the highest area under the curve with a 4 mm cutoff for the extent of ENE (AUC: 0.52). On assessing the impact of adjuvant chemoradiation (CRT) on Ma-ENE and Mi-ENE, only Ma-ENE showed OS (HR: 0.42, 95% CI: 0.18-0.9) and DFS (HR: 0.33, 95% CI: 0.15-0.70) benefit with CRT, which was statistically significant. The revised 4 mm cutoff was predictive of therapeutic benefit with adjuvant CRT (HR: 0.27, 95% CI: 0.1-0.73). Clinicopathological factors with statistically significant interaction with ENE in worsening OS and DFS were tumor location in tongue/floor of mouth (OS), T3/T4 category (OS), depth of invasion greater than 10 mm (OS), ≥ 5 nodes with metastasis (OS), and male sex (DFS).</p><p><strong>Conclusion: </strong>The standard 2 mm cutoff for the extent of ENE failed to reveal sufficient hazard discrimination for OS/DFS. Instead, the 4 mm cutoff determined on ROC analysis was found to have the best predictive ability for DFS.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Stratification for Extranodal Extension in Head and Neck Cancers-Implication for Treatment Intensification.\",\"authors\":\"Smriti Panda, Rajeev Kumar, Aanchal Kakkar, Sandipta Mitra, Vishwajeet Singh, Alok Thakar, Chirom Amit Singh, Kapil Sikka, Anup Singh, Kavneet Kaur, Aman Sharma, Akash Kumar, Amit Kumar, Rachit Sood, Karthika Chettuvatti, Areej Moideen, Nongthombam Surjalata Devi\",\"doi\":\"10.1002/hed.28144\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Extranodal extension (ENE) is an important adverse prognostic indicator for head and neck cancers. However, ENE needs further risk stratification in terms of optimum cutoff for the extent of ENE and interaction with clinicopathological risk factors.</p><p><strong>Methods: </strong>Retrospective single-center study on patients with treatment-naïve head and neck cancer with final histology indicating ENE.</p><p><strong>Results: </strong>Pathological ENE was observed in 122 patients (12.4%). With the 2 mm cutoff separating Mi-ENE and Ma-ENE, no difference was observed in overall survival (OS) and disease-free survival (DFS) for unmatched (OS: 40.9% vs. 33.6%, p = 0.7; DFS: 34.05% vs. 26.12%, p = 0.5) as well as propensity score-matched cohort (OS: HR 1.08, p = 0.82; DFS: HR 0.95, p = 0.89). Receiver-operator curve (ROC) analysis showed the highest area under the curve with a 4 mm cutoff for the extent of ENE (AUC: 0.52). On assessing the impact of adjuvant chemoradiation (CRT) on Ma-ENE and Mi-ENE, only Ma-ENE showed OS (HR: 0.42, 95% CI: 0.18-0.9) and DFS (HR: 0.33, 95% CI: 0.15-0.70) benefit with CRT, which was statistically significant. The revised 4 mm cutoff was predictive of therapeutic benefit with adjuvant CRT (HR: 0.27, 95% CI: 0.1-0.73). Clinicopathological factors with statistically significant interaction with ENE in worsening OS and DFS were tumor location in tongue/floor of mouth (OS), T3/T4 category (OS), depth of invasion greater than 10 mm (OS), ≥ 5 nodes with metastasis (OS), and male sex (DFS).</p><p><strong>Conclusion: </strong>The standard 2 mm cutoff for the extent of ENE failed to reveal sufficient hazard discrimination for OS/DFS. 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引用次数: 0
摘要
背景:结外延伸(ENE)是头颈部肿瘤重要的不良预后指标。然而,就ENE的程度及其与临床病理危险因素的相互作用而言,ENE需要进一步的风险分层。方法:对最终组织学提示ENE的treatment-naïve头颈癌患者进行回顾性单中心研究。结果:病理性ENE 122例(12.4%)。Mi-ENE和Ma-ENE之间以2 mm的分隔,未匹配组的总生存期(OS)和无病生存期(DFS)无差异(OS: 40.9% vs. 33.6%, p = 0.7;DFS: 34.05% vs. 26.12%, p = 0.5)以及倾向评分匹配队列(OS: HR 1.08, p = 0.82;DFS: HR 0.95, p = 0.89)。受试者-操作者曲线(ROC)分析显示,曲线下的最大面积为4 mm (AUC: 0.52)。在评估辅助放化疗(CRT)对Ma-ENE和Mi-ENE的影响时,只有Ma-ENE的OS (HR: 0.42, 95% CI: 0.18-0.9)和DFS (HR: 0.33, 95% CI: 0.15-0.70)受益于CRT,差异有统计学意义。修正后的4毫米截距可预测辅助CRT的治疗效果(HR: 0.27, 95% CI: 0.1-0.73)。与ENE相互作用加重OS和DFS的临床病理因素有:肿瘤位于舌/口底(OS)、T3/T4分型(OS)、浸润深度大于10 mm (OS)、≥5个淋巴结合并转移(OS)、男性(DFS)。结论:标准的2 mm的ENE程度临界值不能充分区分OS/DFS的危害。相反,在ROC分析中确定的4毫米截止点被发现对DFS有最好的预测能力。
Risk Stratification for Extranodal Extension in Head and Neck Cancers-Implication for Treatment Intensification.
Background: Extranodal extension (ENE) is an important adverse prognostic indicator for head and neck cancers. However, ENE needs further risk stratification in terms of optimum cutoff for the extent of ENE and interaction with clinicopathological risk factors.
Methods: Retrospective single-center study on patients with treatment-naïve head and neck cancer with final histology indicating ENE.
Results: Pathological ENE was observed in 122 patients (12.4%). With the 2 mm cutoff separating Mi-ENE and Ma-ENE, no difference was observed in overall survival (OS) and disease-free survival (DFS) for unmatched (OS: 40.9% vs. 33.6%, p = 0.7; DFS: 34.05% vs. 26.12%, p = 0.5) as well as propensity score-matched cohort (OS: HR 1.08, p = 0.82; DFS: HR 0.95, p = 0.89). Receiver-operator curve (ROC) analysis showed the highest area under the curve with a 4 mm cutoff for the extent of ENE (AUC: 0.52). On assessing the impact of adjuvant chemoradiation (CRT) on Ma-ENE and Mi-ENE, only Ma-ENE showed OS (HR: 0.42, 95% CI: 0.18-0.9) and DFS (HR: 0.33, 95% CI: 0.15-0.70) benefit with CRT, which was statistically significant. The revised 4 mm cutoff was predictive of therapeutic benefit with adjuvant CRT (HR: 0.27, 95% CI: 0.1-0.73). Clinicopathological factors with statistically significant interaction with ENE in worsening OS and DFS were tumor location in tongue/floor of mouth (OS), T3/T4 category (OS), depth of invasion greater than 10 mm (OS), ≥ 5 nodes with metastasis (OS), and male sex (DFS).
Conclusion: The standard 2 mm cutoff for the extent of ENE failed to reveal sufficient hazard discrimination for OS/DFS. Instead, the 4 mm cutoff determined on ROC analysis was found to have the best predictive ability for DFS.
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.