Table_1_Pattern of Recurrence After Platinum-Containing Definitive Therapy and Efficacy of Salvage Treatment for Recurrence in Patients with Squamous Cell Carcinoma of the Head and Neck.docx

BackgroundIn first-line systemic therapy for unresectable recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), regimens are generally selected by time-to-relapse with 6 months cutoff after platinum (Pt)-containing definitive therapy, Pt-refractory or Pt-sensitive recurrence, but clinical characteristics between Pt-refractory and Pt-sensitive recurrence of R/M SCCHN has not been fully investigated. This study aimed to evaluate pattern of recurrence and efficacy for salvage treatment for recurrence after Pt-containing definitive therapy for R/M SCCHN in a real-world setting.MethodsWe retrospectively reviewed 150 patients treated with Pt-containing definitive therapy and analyzed the pattern of recurrence and efficacy of salvage therapy for 63 patients with R/M SCCHN.ResultsPt-refractory recurrence, Pt-sensitive recurrence, second primary cancer (SPC), and no relapse occurred in 23.3%, 18.7%, 14.7%, and 43.3% of patients, respectively. In the cases with distant metastatic recurrence, symptomatic recurrence was significantly more common in the Pt-refractory recurrence, while asymptomatic recurrence was significantly more common in the Pt-sensitive recurrence. The timing of detection of SPC was after 2 years in 59.0% of cases after the completion of definitive therapy and 63.6% of SPC were asymptomatic. There was a significant difference in ΔNLR2 (NLR after definitive therapy minus NLR at detection recurrence; p = 0.028) and in prognosis after the detection of recurrence for the overall population (p = 0.021), and for salvage treatment group (p = 0.023), and systemic therapy group (p = 0.003) between Pt-refractory and Pt-sensitive groups.Conclusions and SignificanceOur analysis revealed the recurrence pattern after Pt-containing definitive therapy and showed the validity of dividing patients into Pt-refractory and Pt-sensitive recurrence with different prognosis in salvage therapy, especially systemic therapy.

背景：在不可切除的复发性或转移性头颈部鳞状细胞癌（R/M SCCHN）的首线系统性治疗中，治疗方案通常根据铂（Pt）类药物含有的根治性治疗的复发时间来选择，铂类药物耐药或铂类药物敏感的复发作为截止点，然而，关于铂类药物耐药和铂类药物敏感的R/M SCCHN临床特征的全面研究尚未充分进行。本研究旨在评估铂类药物含有的根治性治疗后的R/M SCCHN复发模式和挽救治疗的有效性，在一个真实世界的环境中进行研究。方法：我们对接受铂类药物含有的根治性治疗的150名患者进行了回顾性分析，并分析了63名R/M SCCHN患者的复发模式和挽救治疗的有效性。结果：铂类药物耐药复发、铂类药物敏感复发、第二原发肿瘤（SPC）和无复发分别发生在23.3%、18.7%、14.7%和43.3%的患者中。在远处转移复发的病例中，铂类药物耐药复发中的症状性复发显著多于铂类药物敏感复发，而无症状复发在铂类药物敏感复发中显著更常见。第二原发肿瘤的检测时间在完成根治性治疗后2年内发生，其中59.0%的病例在完成根治性治疗后2年内检测到第二原发肿瘤，63.6%的第二原发肿瘤无症状。在铂类药物耐药组和铂类药物敏感组之间，整体人群在复发检测后的ΔNLR2（根治性治疗后的NLR减去复发检测时的NLR；p = 0.028）和预后存在显著差异，以及挽救治疗组和系统性治疗组之间存在显著差异（p = 0.023），系统性治疗组（p = 0.003）。结论和意义：我们的分析揭示了铂类药物含有的根治性治疗后的复发模式，并证明了将患者分为铂类药物耐药和铂类药物敏感复发组，在挽救治疗中，尤其是系统性治疗中，根据不同的预后进行划分的有效性。