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Primary radiotherapy or postoperative radiotherapy in patients with head and neck cancer

Comparative analysis of inflammation-based prognostic scoring systems

Primäre oder postoperative Radiotherapie bei Patienten mit Kopf-Hals-Tumoren

Vergleichende Analyse entzündungsbasierter Bewertungssysteme

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Abstract

Introduction

Inflammation-based scoring systems have potential value in evaluating the prognosis of cancer patients; however, detailed comparative analyses in well-characterized head and neck cancer patient collectives are missing.

Methods

We analyzed overall survival (OS) in locally advanced head and neck cancer patients who were treated with curative intent by primary radiotherapy (RT) alone, by RT in combination with cetuximab (RIT) or with cisplatin (RCHT), and by primary surgery followed by postoperative radiotherapy (PORT). The primary RT collective (N = 170) was analyzed separately from the surgery plus RT group (N = 148). OS was estimated using the Kaplan–Meyer method. Cox proportional-hazard regression models were applied to compare the risk of death among patients stratified according to risk factors and the inflammation-based Glasgow Prognostic Score (GPS), the modified GPS (mGPS), the neutrophil–lymphocyte ratio (NLR), the platelet–lymphocyte ratio (PLR), and the prognostic index (PI).

Results

A prognostic relevance of the scoring systems for OS was observed in the primarily irradiated, but not in the PORT collective. OS was 35.5, 18.8, and 15.4 months, respectively, according to GPS 0, 1, and 2. OS according to mGPS 0–2 was identical. The PLR scoring system was not of prognostic relevance, while OS was 27.3 months in the NLR 0 group and 17.3 months in the NLR 1 group. OS was 35.5 months in PI 0, 16.1 months in PI 1, and 22.6 months in PI 2.

Conclusion

GPS/mGPS scoring systems are able to discriminate between three risk groups in primarily, but not postoperatively irradiated locally advanced head and neck cancer patients.

Zusammenfassung

Hintergrund

Entzündungsbasierte Bewertungssysteme haben eine potenzielle Bedeutung für die Beurteilung der Prognose von Krebspatienten. Derzeit fehlen jedoch ausreichend detailliert durchgeführte Analysen in Kollektiven von Patienten mit Kopf-Hals-Tumoren.

Methoden

Untersucht wurde das Gesamtüberleben („overall survival“, OS) von Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren, die in kurativer Intention mit einer alleinigen primären Radiotherapie (RT), mit RT in Kombination mit Cetuximab (RIT) oder Cisplatin (RCHT) sowie mittels primärer Chirurgie gefolgt von postoperativer RT (PORT) behandelt wurden. Patienten, die primär radiotherapiert wurden (N = 170), wurden getrennt vom PORT-Kollektiv (N = 148) analysiert. OS wurde mittels der Kaplan-Meier-Methode ermittelt. Cox-proportionale Hazard-Regressionsmodelle wurden eingesetzt, um das Sterberisiko, stratifiziert nach Risikofaktoren und dem entzündungsbasierten Glasgow-Prognosescore (GPS), dem modifizierten GPS (mGPS), der Neutrophilen-Lymphozyten-Ratio (NLR), der Thrombozyten-Lymphozyten-Ratio (PLR) und dem Prognoseindex (PI) zu vergleichen.

Ergebnisse

Eine prognostische Bedeutung der untersuchten Bewertungssysteme wurde nur in der primär bestrahlten Patientengruppe, jedoch nicht im PORT-Kollektiv gefunden. Das Gesamtüberleben in GPS 0, 1 und 2 betrug jeweils 35,5, 18,8 und 15,4 Monate. Das Gesamtüberleben nach mGPS war in allen Gruppen identisch. Das PLR-Bewertungssystem hatte keine prognostische Relevanz, während das Gesamtüberleben in der NLR-0-Gruppe 27,3 und in der NLR-1-Gruppe 17,3 Monate betrug. Das Gesamtüberleben in PI 0 betrug 35,5, in PI 1 16,1 und in PI 2 22,6 Monate.

Schlussfolgerung

Die GPS/mGPS-Bewertungssysteme können bei primär, jedoch nicht bei postoperativ bestrahlten lokal fortgeschrittenen Kopf-Hals-Tumorpatienten zwischen 3 verschiedenen Risikogruppen diskriminieren.

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Authors and Affiliations

  1. Department of Radiotherapy, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Edgar Selzer MD & Anja Grah

  2. Otorhinolaryngology—Head and Neck Surgery, Medical University of Vienna, Vienna, Austria

    Gregor Heiduschka MD & Dietmar Thurnher MD

  3. Medicine I—Division of Clinical Oncology, Medical University of Vienna, Vienna, Austria

    Gabriela Kornek MD

Authors
  1. Edgar Selzer MD
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  2. Anja Grah
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  3. Gregor Heiduschka MD
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  4. Gabriela Kornek MD
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  5. Dietmar Thurnher MD
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Correspondence to Edgar Selzer MD.

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Conflict of Interest

E. Selzer, A. Grah, G. Heiduschka, G, Kornek, and D. Thurnher state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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E.S. and A.G. should be regarded as equal contributors.

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Selzer, E., Grah, A., Heiduschka, G. et al. Primary radiotherapy or postoperative radiotherapy in patients with head and neck cancer. Strahlenther Onkol 191, 486–494 (2015). https://doi.org/10.1007/s00066-014-0803-1

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  • DOI: https://doi.org/10.1007/s00066-014-0803-1

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