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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 張逸良 | |
dc.contributor.author | Wu-Chia Lo | en |
dc.contributor.author | 羅武嘉 | zh_TW |
dc.date.accessioned | 2021-06-16T09:16:12Z | - |
dc.date.available | 2017-09-12 | |
dc.date.copyright | 2017-09-12 | |
dc.date.issued | 2017 | |
dc.date.submitted | 2017-07-17 | |
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Glasgow prognostic score and neutrophil-lymphocyte ratio are good prognostic indicators after radical neck dissection for advanced squamous cell carcinoma in the hypopharynx. Langenbecks Arch Surg. 2016 May 28. 20. Taguchi T, Nishimura G, Takahashi M, Komatsu M, Sano D, Sakuma N, et al. Treatment results and prognostic factors for advanced squamous cell carcinoma of the hypopharynx treated with concurrent chemoradiotherapy. Cancer Chemother Pharmacol. 2014 Jun;73(6):1147-54. 21. Wei B, Yao M, Xing C, Wang W, Yao J, Hong Y, et al. The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis. Onco Targets Ther. 2016;9:5567-75. 22. Tsai PL, Su WJ, Leung WH, Lai CT, Liu CK. Neutrophil-lymphocyte ratio and CEA level as prognostic and predictive factors in colorectal cancer: A systematic review and meta-analysis. J Cancer Res Ther. 2016 Apr-Jun;12(2):582-9. 23. Qi X, Li J, Deng H, Li H, Su C, Guo X. Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: A systematic review and meta-analysis of observational studies. Oncotarget. 2016 Jul 19;7(29):45283-301. 24. Hu K, Lou L, Ye J, Zhang S. Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis. BMJ open. 2015 Apr 08;5(4):e006404. 25. Zhang X, Zhang W, Feng LJ. Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: a meta-analysis. PloS one. 2014;9(11):e111906. 26. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010 Jan;6(1):149-63. 27. Gao F, Li X, Geng M, Ye X, Liu H, Liu Y, et al. Pretreatment neutrophil-lymphocyte ratio: an independent predictor of survival in patients with hepatocellular carcinoma. Medicine. 2015 Mar;94(11):e639. 28. Ho CM, Ng WF, Lam KH, Wei WI, Yuen AP. Radial clearance in resection of hypopharyngeal cancer: an independent prognostic factor. Head Neck. 2002 Feb;24(2):181-90. 29. Dayyani F, Etzel C, Liu M, Ho C, Lippman SM, Tsao AS. Meta-analysis of the impact of human papillomavirus (HPV) on cancer risk and overall survival in head and neck squamous cell carcinoma (HNSCC). Head Neck Oncol. 2010 Jun 29;2:15. 30. Ardi VC, Kupriyanova TA, Deryugina EI, Quigley JP. Human neutrophils uniquely release TIMP-free MMP-9 to provide a potent catalytic stimulator of angiogenesis. Proc Natl Acad Sci U S A. 2007 Dec 18;104(51):20262-7. 31. Jablonska E, Puzewska W, Grabowska Z, Jablonski J, Talarek L. VEGF, IL-18 and NO production by neutrophils and their serum levels in patients with oral cavity cancer. Cytokine. 2005 May 07;30(3):93-9. 32. Dunn GP, Old LJ, Schreiber RD. The immunobiology of cancer immunosurveillance and immunoediting. Immunity. 2004 Aug;21(2):137-48. 33. Hoffmann TK, Dworacki G, Tsukihiro T, Meidenbauer N, Gooding W, Johnson JT, et al. Spontaneous apoptosis of circulating T lymphocytes in patients with head and neck cancer and its clinical importance. Clin Cancer Res. 2002 Aug;8(8):2553-62. 34. Dequanter D, Zouaoui Boudjeltia K, Shahla M, Aubert C, Lothaire P. Prognostic value of lymph node ratio for locoregional failure in patients with advanced head and neck cancers. Minerva Stomatol. 2016 Feb;65(1):39-42. 35. Ryu IS, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY. Lymph node density as an independent predictor of cancer-specific mortality in patients with lymph node-positive laryngeal squamous cell carcinoma after laryngectomy. Head Neck. 2015 Sep;37(9):1319-25. 36. Joo YH, Cho KJ, Lee YS, Kim SY, Kim MS. Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma. Acta Otolaryngol. 2016 May 18:1-5. 37. Kim SY, Nam SY, Choi SH, Cho KJ, Roh JL. Prognostic value of lymph node density in node-positive patients with oral squamous cell carcinoma. Ann Surg Oncol. 2011 Aug;18(8):2310-7. 38. Shrime MG, Bachar G, Lea J, Volling C, Ma C, Gullane PJ, et al. Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity. Head Neck. 2009 Nov;31(11):1482-8. 39. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013 Oct;88(1):218-30. 40. Kano S, Homma A, Hatakeyama H, Mizumachi T, Sakashita T, Kakizaki T, et al. Pretreatment lymphocyte-to-monocyte ratio as an independent prognostic factor for head and neck cancer. Head Neck. 2017 Feb;39(2):247-53. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/59111 | - |
dc.description.abstract | 下咽癌其組織學表現如同其他頭頸部癌症一樣都是以鱗狀上皮細胞癌居多,然而其臨床的表現卻和其他部位的頭頸癌不一樣。常常在診斷之時已經是晚期、病人營養狀況差、時常有淋巴結甚至是遠端的轉移,以及經常伴隨有第二癌的發生等這些因素使的下咽癌的患者其預後較其他頭頸癌來的差。在現實中,大多數的病人不管其原發部位的大小或淋巴轉移的程度是如何,往往在診斷之時都是第三期或第四期,在這樣不同的排列組合(原發與頸部)之下,有時候不易預估治療的效果與預後,因此,本研究目的在於調查腫瘤大小達到分類3-4(T3-4)或第四期(stage IV)的下咽鱗狀上皮細胞癌患者其臨床病理之預後因子以及希望能擴展傳統的腫瘤、淋巴和轉移(TNM)分期系統使其更具有預測預後的能力。
本回朔性分析,共收納了台大醫院2001年至2008年間接受完整手術治療腫瘤大小達到分類3-4(T3-4)或第四期(stage IV)的下咽癌病人。所有患者在病理診斷下皆為T3-4或stage IV,並且在手術後接受了完整的合併性放化療或放射線治療。第一部分的研究共有105位T3-4的患者被納入,這群病人五年disease-free,disease-specific及overall 存活率分別為47.2%,50.6%及44.8%,治療前的噬中性球比淋巴球比值(neutrophil-to-lymphocyte ratio, NLR)和病人的復發以及存活相關。高NLR(≥ 3.22)的病人和低NLR(< 3.22)的病人相比,其五年的疾病復發率分別為60.4% 和36.5%,達到統計上有意義的差異。多變項分析也顯示高NLR的病人其disease-free,disease-specific及overall 存活率都出現顯著的下降,因此,我們發現在T3-4的患者中治療前若出現有高NLR(≥ 3.22)則和疾病的復發以及較差的存活有關。 第二部分的研究共有120位stage IV的患者被納入,這群病人五年disease-free,disease-specific及overall 存活率分別為48.0%,51.6%及44.6%,我們發現惡性淋巴結比率(LN ratio)和病人的復發以及存活有關。多變項分析也顯示在同樣是第四期的患者當中高LN ratio (≥ 0.113)的病人其disease-free,disease -specific及overall存活率和低LN ratio (< 0.113)的病人相比都出現顯著的下降,另外,高LN ratio (≥ 0.113)的患者其原發部位復發率、頸部復發率或遠端轉移率都較低LN ratio (< 0.113)來的高,就整個疾病有無復發來看,高LN ratio和低LN ratio的病人相比,其疾病復發率分別為68.2%及39.5%,達到統計上顯著的差異。 總結而言,我們發現手術治療前的NLR ≥ 3.22或著是手術後的LN ratio ≥ 0.113分別在T3-4或著是stage IV的下咽癌患者中和疾病復發與存活顯著相關。我們提出可用NLR及LN ratio來擴充現有的TNM分期系統的預後能力;另外,我們需要發展一套更有效的治療策略用在治療高NLR和高LN ratio的病人族群上,這群高風險的下咽癌病人,不論是在臨床或基礎試驗上,均是我們未來的努力方向。 | zh_TW |
dc.description.abstract | The behavior of hypopharyngeal cancer is different from those cancers arising from other head and neck subsites, despite their similar histological presentation. Frequent advanced stage at presentation, poor nutrition, common lymphatic and systemic spread, and predisposition to development of second malignancies are the main causes of its poor prognosis. Owing to the reality that most patients are diagnosed to have stage III or IV disease in spite of different size of primary lesions or even nodal classification, it is sometimes difficult to estimate treatment outcome in this heterogeneous combination. Therefore, this study aimed to investigate the clinicopathological prognostic predictors of resected T3-4 or stage IV hypopharyngeal squamous cell carcinomas (SCCs) and extend the traditional TNM classification system to advance its predictive ability.
We performed a case note review of T3-4 or stage IV hypopharyngeal SCC patients treated with pharyngolaryngectomy and neck dissection between January 2001 and December 2008 in one tertiary center. All patients had pathological T3-4 or stage IV disease and received planned adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) treatment. In the first part of our study, a total of 105 patients with pathologically T3-4 hypopharyngeal cancer were enrolled. The 5-year disease-free, disease-specific and overall survivals of all the patients were 47.2%, 50.6% and 44.8%, respectively. The pretreatment neutrophil-to-lymphocyte ratio (NLR; median, 3.22; range, 0.62-46.50) was associated with disease recurrence and patient survival. A difference in the 5-year cumulative disease recurrence rate between patients with high NLRs (≥ 3.22) and low NLRs (< 3.22) was significant (60.4% and 36.5%, respectively; p = 0.004). A multivariate analysis confirmed that an NLR ≥ 3.22 was an independent indicator of a poor prognosis for advanced hypopharyngeal SCC per the following parameters: overall survival [hazard ratio (HR) 2.53, 95% confidence interval (CI) 1.48-4.30, p = 0.001], disease-specific survival (HR 2.45, 95% CI 1.38-4.34, p = 0.002), and disease-free survival (HR 2.18, 95% CI 1.24-3.83, p = 0.007). An NLR ≥ 3.22 is associated with a higher risk of disease recurrence and poor survival in patients with resected T3-4 hypopharyngeal SCCs. In the second part of our study, a total of 120 patients with pathologically stage IV hypopharyngeal cancer were enrolled. The 5-year disease-free, disease-specific and overall survivals of all the patients were 48.0%, 51.6% and 44.6%, respectively. The lymph node ratio (mean, 0.113; range, 0-1) was associated with disease recurrence and patient survival. In multivariate analysis, lymph node (LN) ratio ≥ 0.113 was a significant poor prognostic factor for OS [hazard ratio (HR) 1.89, 95 % confidence interval (CI) 1.17-3.05, p = 0.009], DSS (HR 2.17, 95 % CI 1.29-3.64, p = 0.003), and DFS (HR 2.24, 95 % CI 1.12-4.52, p = 0.024) in stage IV hypopharyngeal cancer. Patients with LN ratio ≥ 0.113 had significantly ( all ps < 0.05) higher rates of local failure (25.0 % vs. 6.4 %), regional recurrence (25.0 % vs. 9.2 %) and distant metastases (50.0 % vs. 31.6 %) than those with LN ratio < 0.113. Furthermore, we found that patients with LN ratio ≥ 0.113 or < 0.113 had significantly difference in disease recurrence (68.2 % vs. 39.5 %, respectively; p = 0.002). In conclusion, we found that pretreatment NLR ≥ 3.22, and LN ratio ≥ 0.113 had significant relation with disease control and treatment outcomes in patients with T3-4, and stage IV hypopharyngeal SCCs, respectively. We propose the use of an NLR and LN ratio to broaden the current TNM staging system to advance its predictive ability; the development of a more effective treatment protocol for patients with either high NLRs or high LN ratio will be essential and merits basic or clinical studies in the future. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T09:16:12Z (GMT). No. of bitstreams: 1 ntu-106-D02444001-1.pdf: 1528723 bytes, checksum: 442309f3b126ffb4be4fffd8e4f3b06d (MD5) Previous issue date: 2017 | en |
dc.description.tableofcontents | 目錄
論文口試委員會審定書 I 誌謝 II 中文摘要 III 英文摘要 V Chapter 1 Introduction 1 Chapter 2 Materials and Methods 3 2.1 Patient population 3 2.2 Clinicopathological analysis of advanced (T3-4 or stage IV) hypopharyngeal squamous cell carcinoma 3 2.3 Statistical analysis 4 Chapter 3 Results 6 3.1. Patient demographics of T3-4 hypopharyngeal cancer 6 3.2. Univariate analysis result of T3-4 hypopharyngeal squamous cell carcinoma 6 3.3. Multivariate analysis result of T3-4 hypopharyngeal squamous cell carcinoma 7 3.4 Pretreatment neutrophil-to-lymphocyte ratio was associated with survival outcomes in T3-4 hypopharyngeal cancer 7 3.5 Patient demographics of stage IV hypopharyngeal cancer 7 3.6 Univariate analysis result of stage IV hypopharyngeal squamous cell carcinoma 8 3.7 Multivariate analysis result of stage IV hypopharyngeal squamous cell carcinoma 8 3.8 Lymph node ratio was associated with survival outcomes in stage IV hypopharyngeal cancer 9 Chapter 4 Discussion 10 4.1 The reported clinopathological prognostic factors of hypopharyngeal squamous cell carcinoma 10 4.2 The association between pretreatment neutrophil-to-lymphocyte ratio and treatment outcomes of advanced hypopharyngeal cancer 10 4.3 The meaning of high pretreatment neutrophil-to-lymphocyte ratio 11 4.4 The significant negative impact of high pretreatment neutrophil-to-lymphocyte ratio on treatment outcomes of T3-4 hypopharyngeal cancer 12 4.5 Other independent clinicopathological prognostic factors in T3-4 hypopharyngeal cancer 12 4.6 The association between lymph node ratio and treatment outcomes of stage IV hypopharyngeal cancer 13 4.7 The significant negative impact of high lymph node ratio on treatment outcomes of stage IV hypopharyngeal cancer 14 4.8 Other independent clinicopathological prognostic factors in stage IV hypopharyngeal cancer 14 4.9 Limitation 15 Chapter 5 Conclusion 16 References 17 圖一: Kaplan-Meier analyses of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) for all patients with T3-4 hypopharyngeal squamous cell carcinoma 22 圖二: Kaplan-Meier analyses of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) per the NLR in T3-4 hypopharyngeal cancer patients. 25 圖三: Kaplan-Meier analyses of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) for all patients with stage IV hypopharyngeal squamous cell carcinoma 28 圖四: The 5-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) for pathologically stage IV hypopharyngeal patients with low LN ratio versus high LN ratio 31 表一: Characteristics and clinicopathological parameters of the T3-4 hypopharyngeal cancer patients 34 表二: Comparison of OS, DSS and DFS outcomes per the clinicopathological variables in patients with T3-4 hypopharyngeal SCCs 36 表三: Multivariate analyses using a stepwise Cox regression model adjusted by age and gender to clinicopathological factors in T3-4 hypopharyngeal SCCs 39 表四: Disease recurrence per the NLR in patients with T3-4 hypopharyngeal SCCs 40 表五: Characteristics and clinicopathological parameters of stage IV hypopharyngeal cancer patients 41 表六: Univariate analyses of clinicopathological factors for OS, DSS and DFS in stage IV hypopharyngeal cancer 43 表七: Multivariate analyses of clinicopathological factors for OS, DSS and DFS in stage IV hypopharyngeal cancer 45 表八: Disease recurrence according to the LN ratio in patients with stage IV hypopharyngeal cancer 46 | |
dc.language.iso | en | |
dc.title | 晚期下咽癌臨床病理表現及其對手術治療預後的影響 | zh_TW |
dc.title | The clinicopathological expressions in resected advanced hypopharyngeal squamous cell carcinoma and the prognostic impact thereof | en |
dc.type | Thesis | |
dc.date.schoolyear | 105-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 柯政郁,王成平,鄭博文,廖立人 | |
dc.subject.keyword | 下咽癌,鱗狀上皮細胞癌,惡性淋巴結比率(LN ratio),噬中性球比淋巴球比值(NLR),預後,放射線化學治療,存活, | zh_TW |
dc.subject.keyword | hypopharyngeal cancer,squamous cell carcinoma,lymph node ratio,neutrophil-to-lymphocyte ratio,prognosis,chemoradiation,survival, | en |
dc.relation.page | 46 | |
dc.identifier.doi | 10.6342/NTU201701427 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2017-07-17 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 病理學研究所 | zh_TW |
顯示於系所單位: | 病理學科所 |
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