BACKGROUND After surgery for head and neck squamous cell carcinoma (HNSCC), decisions regarding adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) are based on staging and the presence of high-risk pathology. Because higher mutant allele tumor heterogeneity (MATH; a measure of intratumor genetic heterogeneity) is associated with shorter overall survival (OS) in patients with HNSCC, the authors sought to determine whether MATH analysis might further inform these decisions. METHODS Adjuvant therapy-associated relationships between MATH and OS were analyzed for 389 patients with HNSCC who were treated surgically. Data were obtained from The Cancer Genome Atlas and analyzed with Cox proportional hazards multiple regression accounting for 7 other patient characteristics. RESULTS The relationship between MATH and OS differed with adjuvant therapy in a way that could inform therapy decisions. Adjuvant RT alone was found to provide substantial benefit for patients having high-MATH tumors (RT vs no adjuvant therapy: hazard ratio, 0.29 [95% CI, 0.17-0.51]) but no benefit for those having low-MATH tumors. In contrast, adjuvant CRT provided no benefit beyond that of adjuvant RT for patients with high-MATH tumors but substantially improved OS among patients with low-MATH tumors (CRT vs no adjuvant therapy: hazard ratio, 0.34 [95% CI, 0.15-0.78]). CONCLUSIONS The results of the current analysis suggested that patients with HNSCC with high-MATH tumors who underwent surgical treatment could benefit from adjuvant RT, even when current clinical guidelines indicate otherwise. The addition of adjuvant chemotherapy for patients with high-MATH tumors would not be indicated. Adding chemotherapy might be necessary to radiosensitize low-MATH tumors to adjuvant RT. This potential predictive role of tumor MATH analysis should be evaluated in prospective clinical trials.

中文翻译：

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肿瘤内异质性可以为头颈部鳞状细胞癌患者的术后辅助治疗方法和类型提供信息。

背景技术在头颈鳞状细胞癌（HNSCC）手术后，关于辅助放疗（RT）或放化疗（CRT）的决定取决于分期和高危病理。由于较高的突变体等位基因肿瘤异质性（MATH；一种衡量肿瘤内遗传异质性的方法）与HNSCC患者较短的总生存期（OS）相关，因此作者试图确定MATH分析是否可以进一步为这些决定提供依据。方法分析389例经手术治疗的HNSCC患者的MATH与OS之间的辅助治疗相关性。数据来自《癌症基因组图谱》，并用Cox比例风险多元回归分析了其他7种患者特征。结果MATH和OS之间的关系因辅助治疗而有所不同，可以为治疗决策提供依据。发现仅辅助放疗可为患有高MATH肿瘤的患者提供实质性益处（RT与无辅助治疗：危险比为0.29 [95％CI，0.17-0.51]），但对患有低MATH肿瘤的患者则无益处。相比之下，对于高MATH肿瘤患者，辅助CRT不能提供超过辅助RT的益处，但是对于低MATH肿瘤患者而言，OS显着改善（CRT与无辅助治疗：危险比为0.34 [95％CI，0.15-0.78 ]）。结论当前的分析结果表明，即使当前的临床指南另有说明，接受手术治疗的患有高MATH肿瘤的HNSCC患者也可以从辅助RT中获益。对于高MATH肿瘤患者，不建议增加辅助化疗。对于低MATH肿瘤对辅助RT放射敏感性可能需要增加化疗。应当在前瞻性临床试验中评估肿瘤MATH分析的这一潜在预测作用。