Groome P A, O'Sullivan B, Irish J C, Rothwell D M, Math K S, Bissett R J, Dixon P R, Eapen L J, Gulavita S P, Hammond J A, Hodson D I, Mackenzie R G, Schneider K M, Warde P R, Mackillop W J
Radiation Oncology Research Unit, Departments of Oncology and Community Health and Epidemiology, Queens University, Kingston, Ontario, Canada.
J Clin Epidemiol. 2001 Mar;54(3):301-15. doi: 10.1016/s0895-4356(00)00295-x.
We compared the management and outcome of glottic cancer in Ontario, Canada to that in the Surveillance, Epidemiology and End Results (SEER) Program areas in the United States to determine whether the greater use of primary radiotherapy with surgery reserved for salvage in Ontario was associated with similar survival and better larynx retention rates than the U.S. approach where primary surgery is used more often. Electronic, clinical and hospital data were linked to cancer registry data and supplemented by chart review where necessary. Initial treatment and survival in patients diagnosed in the SEER areas from 1988 through 1994 were compared to patients from Ontario diagnosed from 1982 through 1995. Actuarial laryngectomy rates were compared for patients over 65 at diagnosis in the two regions. Analyses were conducted over all cases and stratified by disease stage. In localized disease (T1 or T2), conservative treatment was the most common initial treatment in both regions, although total laryngectomy was used more often in SEER than Ontario (6.2% vs. 0.2%, respectively, P <.001). In advanced disease (T3 or T4), total laryngectomy was more commonly used as initial treatment in SEER (62.9% vs. 21.0% in Ontario, P < or =.001). Over all cases, the relative survival rate was 80% in Ontario at 5 years compared to 78% in SEER (P =.33). In localized disease, the relative survival rates were 4 to 5% higher in Ontario from the second year on, while in advanced disease 2 to 3% higher rates in SEER did not approach statistical significance. Actuarial laryngectomy rates at 3 years differed between the two regions, with a 4% higher rate in SEER (P =.01). In localized disease, 12.6% of Ontario patients had a laryngectomy by 3 years postdiagnosis compared to 17.9% in SEER (P =.05). In advanced disease, the rates were 63.3% and 79.2%, respectively (P =.07). There are large differences in the management of glottic cancer between the SEER areas of the U.S. and Ontario and no evidence that a policy emphasizing radiotherapy with surgery reserved for salvage is associated with worse survival. Ultimate laryngectomy rates are lower in Ontario for localized disease and may be lower for advanced disease. Conservation treatment should be used for localized disease while the treatment decision in advanced disease may be especially sensitive to patient values for voice retention versus initial cure.
我们将加拿大安大略省声门癌的治疗方法及结果与美国监测、流行病学和最终结果（SEER）项目地区的情况进行比较，以确定安大略省更多地采用以手术作为挽救性治疗手段的原发性放疗方法，与美国更常采用原发性手术的方法相比，是否具有相似的生存率以及更高的喉保留率。电子数据、临床数据和医院数据与癌症登记数据相关联，并在必要时通过病历审查进行补充。将1988年至1994年在SEER地区诊断出的患者的初始治疗情况和生存率，与1982年至1995年在安大略省诊断出的患者进行比较。对两个地区诊断时年龄超过65岁的患者的精算喉切除术率进行比较。对所有病例进行分析，并按疾病阶段分层。在局限性疾病（T1或T2）中，保守治疗是两个地区最常见的初始治疗方法，不过SEER地区全喉切除术的使用频率高于安大略省（分别为6.2%和0.2%，P<.001）。在晚期疾病（T3或T4）中，SEER地区更常将全喉切除术作为初始治疗方法（安大略省为21.0%，SEER地区为62.9%，P≤.001）。在所有病例中，安大略省5年相对生存率为80%，而SEER地区为78%（P =.33）。在局限性疾病中，从第二年起安大略省的相对生存率高出4%至5%，而在晚期疾病中，SEER地区高出2%至3%，但未达到统计学显著性。两个地区3年的精算喉切除术率存在差异，SEER地区高出4%（P =.01）。在局限性疾病中，安大略省12.6%的患者在诊断后3年内接受了喉切除术，而SEER地区为17.9%（P =.05）。在晚期疾病中，这一比例分别为63.3%和79.2%（P =.07）。美国SEER地区和安大略省在声门癌治疗方法上存在很大差异，且没有证据表明强调放疗并将手术作为挽救性治疗手段的政策会导致生存率降低。安大略省局限性疾病的最终喉切除术率较低，晚期疾病的最终喉切除术率可能也较低。局限性疾病应采用保守治疗，而晚期疾病的治疗决策可能对患者保留嗓音与初始治愈的价值观尤为敏感。
