Identification of High-Risk Subgroups of Patients With Oral Cavity Cancer in Need of Postoperative Adjuvant Radiotherapy or Chemo-Radiotherapy

被引:46
作者
Chen, Wen-Cheng [1 ,2 ,3 ]
Lai, Chia-Hsuan [1 ,3 ]
Fang, Chiung-Cheng [1 ]
Yang, Yao-Hsu [3 ,4 ,5 ,6 ]
Chen, Pau-Chung [3 ,5 ,6 ,7 ]
Lee, Chuan-Pin [3 ]
Chen, Miao-Fen [1 ,2 ,3 ]
机构
[1] Chang Gung Mem Hosp, Dept Radiat Oncol, Chiayi, Taiwan
[2] Chang Gung Univ, Coll Med, Taoyuan, Taiwan
[3] Chang Gung Mem Hosp, Ctr Excellence Chang Gung Res Datalink, Chiayi, Taiwan
[4] Chang Gung Mem Hosp, Tradit Chinese Med, Chiayi, Taiwan
[5] Natl Taiwan Univ, Coll Publ Hlth, Inst Occupat Med & Ind Hyg, Taipei 10764, Taiwan
[6] Natl Taiwan Univ Hosp, Dept Environm & Occupat Med, Taipei, Taiwan
[7] Natl Taiwan Univ, Coll Med, Taipei 10764, Taiwan
关键词
SQUAMOUS-CELL CARCINOMA; LOCALLY ADVANCED HEAD; NECK-CANCER; RANDOMIZED-TRIAL; CHEMOTHERAPY; SURGERY; IRRADIATION; RECURRENCE; CISPLATIN; STAGE;
D O I
10.1097/MD.0000000000003770
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Patients with oral cavity squamous cell carcinoma (OSCC) undergoing surgery are recommended to receive adjuvant radiation therapy with or without chemotherapy if there are unfavorable prognostic factors. A positive resection margin (PRM) and extra-capsular extension (ECE) of lymph nodes are well-known major prognostic factors. However, there is no agreement on whether oral cavity cancer patients should receive postoperative chemo-radiotherapy (CCRT) if they present with other risk factors or a combination of 2 or more risk factors. In this study, we investigated this issue and provide suggestions for adjuvant treatments. From January 2002 to December 2013, 567 OSCC patients who had undergone radical surgery were retrospectively reviewed. The 5-year loco-regional control (LRC), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) were analyzed. In univariate analysis, pathological T classification, positive node, tumor depth, ECE, lymphatic or vascular or perineural invasion and histology grade are significant prognostic factors for LRC, DMF, DFS, or OS. By multivariate analysis, pathological T4 (pT4), positive node, positive surgical margin are prognostic factors for LRC. pT4, positive node and lymphatic invasion predicted for higher rate of distant metastasis. pT4, positive node, and poor differentiation tumor were prognostic factors for DFS. pT4, positive nodes, and ECE were prognostic factors for OS. These factors were used to define risk groups. We proposed PRM and ECE as major risk factors and pT4, positive nodes, close margin (<= 5 mm, >1 mm), tumor depth >= 1 cm, lymphatic invasion, vascular invasion, perineural invasion, and poor differentiation as minor risk factors. By subgroups analysis, 192 patients with at least 2 minor prognostic factors and no other major risk factors, postoperative radiotherapy (RT), or CCRT yielded significantly better 5-year LRC, DFS, and OS compared to surgery only group. For 179 patients with at least 3 minor prognostic factors and/or at least 1 major risk factor, patients receiving postoperative CCRT showed significantly better 5-year LRC, DFS, and OS compared with post-OP RT or surgery alone. Patients with 2 minor risk factors should receive postoperative RT. For patients with PRM, ECE, or > 2 minor risk factors, postoperative CCRT is recommended.
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页数:8
相关论文
共 19 条
[1]   A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma [J].
Anderson, Caroline Rachael ;
Sisson, Katherine ;
Moncrieff, Marc .
ORAL ONCOLOGY, 2015, 51 (05) :464-469
[2]   Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer [J].
Ang, KK ;
Trotti, A ;
Brown, BW ;
Garden, AS ;
Foote, RL ;
Morrison, WH ;
Geara, FB ;
Klotch, DW ;
Goepfert, H ;
Peters, LJ .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2001, 51 (03) :571-578
[3]   Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: Final report of a randomized trial [J].
Bachaud, JM ;
CohenJonathan, E ;
Alzieu, C ;
David, JM ;
Serrano, E ;
DalySchveitzer, N .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1996, 36 (05) :999-1004
[4]   Defining risk levels in locally advanced head and neck cancers:: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501) [J].
Bernier, J ;
Cooper, JS ;
Pajak, TF ;
van Glabbeke, M ;
Bourhis, J ;
Forastiere, A ;
Ozsahin, EM ;
Jacobs, JR ;
Jassem, J ;
Ang, KK ;
Lefèbvre, JL .
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 2005, 27 (10) :843-850
[5]   Chemoradiation after surgery for high-risk head and neck cancer patients: How strong is the evidence? [J].
Bernier, J ;
Cooper, JS .
ONCOLOGIST, 2005, 10 (03) :215-224
[6]   Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer [J].
Bernier, J ;
Domenge, C ;
Ozsahin, M ;
Matuszewska, K ;
Lefèbvre, JL ;
Greiner, RH ;
Giralt, J ;
Maingon, P ;
Rolland, F ;
Bolla, M ;
Cognetti, F ;
Bourhis, J ;
Kirkpatrick, A ;
van Glabbeke, M .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (19) :1945-1952
[7]   PERINEURAL SPREAD IN SQUAMOUS-CELL CARCINOMAS OF THE HEAD AND NECK - CLINICO-PATHOLOGICAL STUDY [J].
CARTER, RL ;
TANNER, NSB ;
CLIFFORD, P ;
SHAW, HJ .
CLINICAL OTOLARYNGOLOGY, 1979, 4 (04) :271-281
[8]   Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck [J].
Cooper, JS ;
Pajak, TF ;
Forastiere, AA ;
Jacobs, J ;
Campbell, BH ;
Saxman, SB ;
Kish, JA ;
Kim, HE ;
Cmelak, AJ ;
Rotman, M ;
Machtay, M ;
Ensley, JF ;
Chao, KSC ;
Schultz, CJ ;
Lee, N ;
Fu, KK .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (19) :1937-1944
[9]  
Edge SB BD., 2009, Cancer Staging Manual, V7th
[10]   Prognostic impact of perineural invasion and lymphovascular invasion in advanced stage oral squamous cell carcinoma [J].
Jardim, J. F. ;
Francisco, A. L. N. ;
Gondak, R. ;
Damascena, A. ;
Kowalski, L. P. .
INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2015, 44 (01) :23-28