Objective

Clinical outcomes of patients with resected oral cavity squamous cell carcinoma (OCSCC) chiefly depend on the presence of specific clinicopathological risk factors (RFs). Here, we performed a combined analysis of FDG-PET, genetic markers, and clinicopathological RFs in an effort to improve prognostic stratification.

Methods

We retrospectively reviewed the clinical records of 2036 consecutive patients with first primary OCSCC who underwent surgery between 1996 and 2016. Of them, 345 underwent ultra-deep targeted sequencing (UDTS, between 1996 and 2011) and 168 whole exome sequencing (WES, between 2007 and 2016). Preoperative FDG-PET imaging was performed in 1135 patients from 2001 to 2016. Complete data on FDG-PET, genetic markers, and clinicopathological RFs were available for 327 patients.

Results

Using log-ranked tests based on 5-year disease-free survival (DFS), the optimal cutoff points for maximum standardized uptake values (SUV-max) of the primary tumor and neck metastatic nodes were 22.8 and 9.7, respectively. The 5-year DFS rates were as follows: SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7 (n = 77) versus SUVtumor-max < 22.8 and SUVnodal-max < 9.7 (n = 250), 32%/62%, P < 0.001; positive UDTS or WES gene panel (n = 64) versus negative (n = 263), 25%/62%, P < 0.001; pN3b (n = 165) versus pN1-2 (n = 162), 42%/68%, P < 0.001. On multivariate analyses, SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7, a positive UDTS/WES gene panel, and pN3b disease were identified as independent prognosticators for 5-year outcomes. Based on these variables, we devised a scoring system that identified four distinct prognostic groups. The 5-year rates for patients with a score from 0 to 3 were as follows: loco-regional control, 80%/67%/47%/24% (P < 0.001); distant metastases, 13%/23%/55%/92% (P < 0.001); DFS, 74%/58%/28%/7% (P < 0.001); and disease-specific survival, 80%/64%/35%/7% (P < 0.001) respectively.

Conclusions

The combined assessment of tumor and nodal SUV-max, genetic markers, and pathological node status may refine the prognostic stratification of OCSCC patients.

中文翻译：

---

对FDG-PET，遗传标志物和临床病理危险因素的最大标准化摄取值进行联合分析，以分析口腔鳞状细胞癌切除患者的预后。

客观的

口腔鳞状细胞癌（OCSCC）切除患者的临床结局主要取决于特定的临床病理危险因素（RF）的存在。在这里，我们进行了FDG-PET，遗传标记和临床病理RF的组合分析，以改善预后分层。

方法

我们回顾性研究了1996年至2016年间连续进行手术的2036例第一原发性OCSCC患者的临床记录。其中，345例接受了超深度靶向测序（UDTS，1996年至2011年）和168例全外显子测序（WES，2007年之间）和2016年）。从2001年至2016年，对1135例患者进行了术前FDG-PET成像。327例患者可获得有关FDG-PET，遗传标记和临床病理RF的完整数据。

结果

使用基于5年无病生存期（DFS）的对数排名测试，原发性肿瘤和颈部转移淋巴结的最大标准摄取值（SUV-max）的最佳分界点分别为22.8和9.7。5年DFS率如下：SUVtumor-max≥22.8或SUVnodal-max≥9.7（n  = 77）与SUVtumor-max <22.8和SUVnodal-max <9.7（n  = 250），32％/ 62％，P  <0.001；UDTS或WES基因组阳性（n  = 64）与阴性（n  = 263），25％/ 62％，P  <0.001; pN3b（n  = 165）与pN1-2（n  = 162），42％/ 68％，P <0.001。在多变量分析中，将SUVtumor-max≥22.8或SUVnodal-max≥9.7，UDTS / WES基因组阳性和pN3b疾病确定为5年预后的独立预后因子。基于这些变量，我们设计了一个评分系统，该评分系统确定了四个不同的预后组。评分从0到3的患者的5年率如下：局部区域控制率为80％/ 67％/ 47％/ 24％（P  <0.001）；远处转移率为13％/ 23％/ 55％/ 92％（P  <0.001）; DFS，74％/ 58％/ 28％/ 7％（P  <0.001）; 疾病特异性生存率分别为80％/ 64％/ 35％/ 7％（P  <0.001）。

结论

肿瘤和淋巴结SUV-max，遗传标记和病理结节状态的综合评估可以改善OCSCC患者的预后分层。