背景:研究表明,关于原发性肿瘤体积(TV)和转移性淋巴结(NV)体积在局部晚期头颈部鳞状细胞癌(LAHNSCC)确定性放疗疗效中的作用。
目的:我们旨在评估TV和NV对LAHNSCC患者根治性放疗疗效的影响,以指导个体化治疗为目标。
方法:选择2012年1月至2021年12月接受根治性放射治疗并在治疗后6个月内复查的LAHNSCC患者。通过软件计算原发肿瘤和转移淋巴结的体积,然后根据与中位数的关系将其分为大电视组vs小电视组和大NV组vs小NV组。此外,接受或未接受同步放化疗(CCRT)的患者分为CCRT组和放疗(RT)组.淋巴结转移患者根据是否接受同步化疗分为淋巴结同步化疗(N-CCRT)组和淋巴结转移化疗(N-RT)组。体积收缩率(VSR),客观反应率(ORR),记录并分析局部控制率(LCR)和总生存期(OS).
结果:96例患者被纳入原发肿瘤体积组,淋巴结转移组包括73例患者。为客观缓解(OR)终点构建受试者工作特征(ROC)曲线,并为TV和NV患者定义容量阈值.阈值原发肿瘤体积为32.45cm3,阈值转移淋巴结体积为6.05cm3。小型电视和大型电视集团的初级电视收缩率基本一致,P=0.801。同样,小电视组和大电视组之间的ORR和LCR没有显着差异(PORR=0.118,PLCR=0.315)。此外,CCRT组与RT组之间的TV收缩率没有显着差异,P=0.133。此外,CCRT组ORR和LCR差异无统计学意义(PORR=0.057,PLCR=0.088)。然而,小NV组转移淋巴结体积收缩率明显大于大NV组(P=0.001)。小NV亚组的ORR和LCR显著大于大NV亚组(PORR=0.002,PLCR=0.037)。此外,与N-RT组相比,N-CCRT组的NV收缩率为84.10±s3.11%,收缩率为70.76±s5.77%(P=0.047)。对于ORR和LCR,N-CCRT组与N-RT组差异有统计学意义(PORR=0.030,PLCR=0.037)。全组中位OS为26个月。然而,TV/NV或同步化疗似乎都不影响OS。
结论:原发性肿瘤体积不是LAHNSCC患者放疗疗效的预后因素。然而,转移淋巴结是影响LAHNSCC患者放疗疗效的预后因素。淋巴结较小的患者具有更好的局部控制。
BACKGROUND: Studies have shown mixed results concerning the role of primary tumor volume (TV) and metastatic lymph node (NV) volume in response to the curative effect of definitive radiotherapy for locally advanced head and neck squamous cell carcinoma (LAHNSCC).
OBJECTIVE: We aimed to evaluate the impact of TV and NV on the efficacy of radical radiotherapy in LAHNSCC patients, with the goal of guiding individualized therapy.
METHODS: Patients with LAHNSCC who received radical radiation therapy and were reexamined within 6 months post-therapy from January 2012 to December 2021 were selected. The volumes of the primary tumors and metastatic lymph nodes were calculated by software and then were divided into a large TV group vs small TV group and a large NV group vs small NV group according to the relationship with the median. Additionally, patients who received concurrent chemoradiotherapy (CCRT) or not were divided into the CCRT group and the radiotherapy (RT) group. Patients with lymph node metastasis were divided into node concurrent chemotherapy (N-CCRT) group and a node metastatic chemotherapy (N-RT) group according to whether they received concurrent chemotherapy or not. The volume shrinkage rate (VSR), objective response rate (ORR), local control rate (LCR) and overall survival (OS) were recorded and analyzed.
RESULTS: 96 patients were included in the primary tumor volume group, and 73 patients were included in the metastatic lymph node group. Receiver operating characteristic (ROC) curves were constructed for objective remission (OR) endpoints, and a volume threshold was defined for TV and NV patients. The threshold primary tumor volume was 32.45 cm3, and the threshold metastatic lymph node volume was 6.05 cm3.The primary TV shrinkage rates of the small TV and the large TV groups were basically the same, P = 0.801. Similarly, the ORR and LCR were not significantly different between the small TV group and the large TV group (PORR = 0.118, PLCR = 0.315). Additionally, the TV shrinkage rate did not significantly differ between the CCRT group and the RT group, P = 0.133. Additionally, there was no significant difference in ORR or LCR in CCRT group (PORR = 0.057, PLCR = 0.088). However, the metastatic lymph node volume shrinkage rate in the small NV group was significantly greater than that in the large NV group (P = 0.001). The ORR and LCR of the small NV subgroup were significantly greater than those of the large NV subgroup (PORR = 0.002, PLCR = 0.037). Moreover, compared with that of the N-RT group, the NV shrinkage rate of the N-CCRT group was 84.10 ± s3.11%, and the shrinkage rate was 70.76 ± s5.77% (P = 0.047). For the ORR and LCR, the N-CCRT group and N-RT group were significantly different (PORR = 0.030, PLCR = 0.037). The median OS of the whole group was 26 months. However, neither TV/NV nor concurrent chemotherapy seemed to influence OS.
CONCLUSIONS: Primary tumor volume is not a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Nevertheless, metastatic lymph nodes are a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Patients with smaller lymph nodes have better local control.