转移性颈部淋巴结 V 组在鼻咽癌淋巴结分期中的附加值。
- 作者列表："Setakornnukul J","Thephamongkhol K","Chaysiri P
BACKGROUND:Prognostic significance of posterior cervical lymph node metastasis in nasopharyngeal cancer is largely unknown. This study aims to determine the added prognostic significance of cervical lymph node group V to the standard American Joint Committee on Cancer (AJCC) staging system (eighth edition AJCC) of nasopharyngeal patients with cancer treated with intensity-modulated radiation therapy (IMRT) in terms of overall survival (OS), distant metastatic-free survival (DMFS), and disease-free survival (DFS). METHODS AND MATERIALS:A retrospective cohort of 199 consecutively diagnosed nasopharyngeal patients with cancer treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in the era of IMRT in a large university hospital in endemic area of Southeast Asia. Pre-treatment imaging studies were thoroughly re-evaluated and re-staged by a board-certified radiologist using radiographic criteria for cervical lymph node metastasis. T and N classifications were reclassified according to the eighth AJCC staging system. Group V (Va and Vb) cervical node was evaluated for its added prognostic significance. Cox's proportional hazard model was used to retrieve hazard ratio (HR), 95% confidence interval and P value for N classification. Harrell's C-statistic (concordance index) was used for test of discrimination and internal validation was calculated by bootstrap method. RESULTS:This study demonstrated greater separation of OS with HR of 6.75 (95%CI 1.94-23.51, P = .003) by using group Vb only as N3 compared to HR of 4.70 (95%CI 1.37-16.13, P = .014) by using current standard N3 disease (groups IV and Vb). Similarly, N2 with presence of Va shows worsened DFS with HR of 8.70 (95%CI 1.08-69.67, P = .042) compared to N2 without Va with HR of 5.93 (95%CI 0.76-46.00, P = .089). After incorporating cervical group V into nodal staging, the HR and 95%CI among each group was better separated than the eighth AJCC staging system but without significant improvement in C-index. CONCLUSION:Cervical lymph node group V is a potentially added prognostic factor to standard TNM staging.
背景: 鼻咽癌颈后淋巴结转移的预后意义在很大程度上是未知的。本研究旨在确定颈部淋巴结 V 组对标准美国癌症联合委员会 (AJCC) 分期系统 (第 8 版 AJCC) 的新增预后意义在接受调强放疗 (IMRT) 治疗的鼻咽癌患者中，总生存期 (OS) 、无远处转移生存期 (DMFS) 、和无病生存期 (DFS)。 方法和材料: 回顾性队列研究，199 例连续诊断的鼻咽癌患者接受确定性放疗 (RT) 或同步放化疗 (CCRT) 在东南亚流行区的一家大型大学医院进行 IMRT 的时代。由经委员会认证的放射科医师使用颈部淋巴结转移的影像学标准对治疗前影像学研究进行彻底的重新评估和重新分期。T 和 N 分类根据第八 AJCC 分期系统重新分类。V 组 (Va 和 Vb) 颈淋巴结被评估其增加的预后意义。采用 Cox 比例风险模型检索 N 分类的风险比 (HR) 、 95% 置信区间和 p值。采用 Harrell's C 统计量 (一致性指数) 进行区分性检验，并通过 bootstrap 方法计算内部验证。 结果: 本研究显示了更大的 OS 分离，HR 为 6.75 (95% CI 1.94-23.51，P =.003) 仅使用 Vb 组作为 N3，而使用当前标准 N3 病 (IV 组和 Vb 组) 的 HR 为 4.70 (95% CI 1.37-16.13，P =.014)。同样，存在 Va 的 N2 显示恶化的 DFS，HR 为 8.70 (95% CI 1.08-69.67，P =.042) 与无 Va 的 N2 相比，HR 为 5.93 (95% CI 0.76-46.00，P =.089)。将宫颈 V 组纳入淋巴结分期后，各组间的 HR 和 95% CI 分离优于第八 AJCC 分期系统，但 C 指数无明显改善。 结论: 颈部淋巴结 V 组是标准 TNM 分期的潜在预后因素。
METHODS:INTRODUCTION:Human papillomavirus (HPV) is the most common sexually transmitted infection and is associated with several types of cancer. The number of cases of HPV-associated head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal carcinomas, has increased significantly in recent years despite decreased tobacco smoking rates. Currently, no data concerning the risk factors and prevalence of HPV in HNSCC patients in all regions of Brazil are available, making it difficult to promote advances in this field of public health. Therefore, our goal is to determine the impact of infection by HPV, including HPVs with different genotypes, on head and neck cancer and the risk factors associated with the development of head and neck cancer in all regions of Brazil. METHODS AND ANALYSIS:This is a case-control study that will include 622 patients and 622 controls from all regions of Brazil. A questionnaire will be applied to gather information on sociodemographic, behavioural and health factors. Oral, cervical or penile/scrotal, and anal specimens and serum samples will be collected from all participants. Formalin-fixed paraffin-embedded tissue from tumour biopsies will be analysed only in the case group. Molecular and serological analyses will be performed to evaluate the presence and role of HPV in the development of head and neck cancer. ETHICS AND DISSEMINATION:This project was approved by the research ethical committee of the proposing institution (Hospital Moinhos de Vento, number 2.852.060). Ethical approval from the collaborators is currently under evaluation and is not yet complete. The results of this study will be presented at meetings with the Brazilian Ministry of Health through technical reports and to the scientific community at national and international events, with subsequent publication of scientific articles.
METHODS:BACKGROUND:Factors related to head and neck cancer and the treatment of the disease can affect quality of life. The aim of this study was to determine factors associated with the severity of impact on oral health-related quality of life (OHRQoL) in survivors of head and neck cancer using a multivariate analysis. METHODS:This cross-sectional study evaluated 90 volunteers who had completed radiotherapy at least 3 months earlier. OHRQoL was assessed using oral health impact profile (OHIP-14) and the data were analyzed using robust variance poisson regression models. RESULTS:The mean total OHIP-14 score was 23.98 ± 12.55. Patients with hyposalivation had 56% higher (worse) mean OHIP-14 total scores (CI:1.11-2.18) and patients with advanced stage tumors had 31% higher mean OHIP-14 total scores (CI:1.03-1.66) in multivariate analyses. CONCLUSION:OHRQoL of survivors of head and neck cancer experienced a negative impact following radiotherapy. The impact was associated with hyposalivation and advanced stage tumors.
METHODS:BACKGROUND:To immunohistochemically evaluate the association between the presence of cancer-associated fibroblasts (CAFs) and the tumour expression of podoplanin (PDPN) in head and neck squamous cell carcinoma (HNSCC) and their association with clinicopathological variables. MATERIAL AND METHODS:A tissue microarray (TMA) with biopsy sections from patients diagnosed with HNSCC was stained with antibodies against the CAFs marker, α-smooth muscle actin (α-SMA), and PDPN. We subsequently evaluated their expression to determine the association between them and with clinicopathological variables including age, primary tumour site, TNM stage, and tumour differentiation grade. RESULTS:Positive reaction to α-SMA was observed in the tumour stroma, revealing spindle-shaped cells compatible with CAFs, which showed a high expression in 62% of cases and a significant association with laryngeal carcinomas, advanced clinical stages, and lower tumour differentiation (P ≤ 0.05). PDPN staining on tumour cells showed low expression in 72% of cases, and it was not associated with any clinicopathological variable or with the presence of CAFs. CONCLUSIONS:The presence of CAFs in the tumour stroma is related to an aggressive phenotype and could increase as the disease progresses, although based on our findings, it would have no relationship, at least directly, with the expression of PDPN.