Clinical Profile and Outcome of Viral-Mediated Pharyngeal Carcinoma at a Western Institution
Notice bibliographique
Résumé
To compare clinical profile and outcome between viral-mediated oropharyngeal (OPC) and nasopharyngeal carcinoma (NPC) at a western institution. All newly diagnosed nonmetastatic viral-mediated OPC and NPC treated with IMRT from 2005 to 2014 were reviewed. Viral etiology was confirmed by p16 immuno-staining for HPV and EBER in situ hybridization for EBV. Demographics, the 8th edition TNM for HPV+ OPC (ICON-S) and NPC, failure patterns, and outcomes were compared between OPC and NPC. A total of 802 OPC (801 HPV+; 1 EBV+) and 369 NPC (360 EBER+ and 9 HPV+) were viral-mediated. NPC patients were mostly Asian (75% vs 4%) while most OPC were Caucasian (94% vs 20%) (both P < .01). Compared to NPC, OPC patients were older (median 59 vs 52 years, P < .001), predominantly male (83% vs 67%, P<.001), and had more advanced stage (P < .001). Median follow-up was 5.0 years for the entire cohort. Compared to NPC, OPC had similar 5-year overall survival (OS) (80% vs 87%, P = .073), regional control (96% vs 94%, P = .230) and distant control (88% vs 88%, P = .530). Local control was higher in OPC (96% vs 91%, P<.001) and remained significant after adjusting for T/smoking/age (HR = 0.43, P = .004). Late toxicity rates were marginally lower with OPC (19% vs 25%, P = .062). Similar 5-year RFS was found according to the same TNM stage grid: T1-2N0-1 disease (i.e. early disease: stage I OPC; stage I-II NPC) (91% vs 90%, P = .26), T1-2N2 or T3N0-2 disease (intermediate disease: stage II OPC; stage III NPC) (84% vs 87%, P = .95), and T4 or N3 disease (advanced disease: stage III OPC; stage IVA-IVB NPC) (69% vs 63%, P = .56). Distant metastasis (DM) was the main form of failure and occurred in 92 (11%) OPC and 51 (14%) NPC patients. Most DMs (85% OPC and 76% NPC) did not have locoregional failure (P = .22). Multisite involvement was common in those with DM (51% OPC and 35% NPC) and most evident in lung, liver, and bone. Interestingly, DM to brain was more frequent in OPC versus NPC (13% vs 2%, P = .03). OS after DM for OPC and NPC were similar (5-year: 17% vs 22%, P = .20). Of patients with DM, 24 of 92 (26%) OPC and 15 of 51 (29%) NPC survived more than 2 years after DM. This large western cohort study shows that ethnic susceptibility remains after inter-continental migration. Viral type has a distinct anatomic preference. HPV usually causes OPC, but may occasionally cause NPC. The outcome and pattern of failure are very similar by the 8th edition TNM classification. However, local control is slightly lower in NPC, likely reflecting anatomic challenges in NPC. DM is the main form of failure for both NPC and OPC but long-term survivors after DM are seen in the 2 diseases. Such similarities in clinical behavior could reflect common mechanisms of oncogenesis, metastasis, and radio-/chemo-sensitivity and/or resistance induced by HPV and EBV.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».