Hathaway B, Johnson J T, Piccirillo J F, Snyderman C H, Wagner R L, Labriola S, Myers E N
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Laryngoscope. 2001 Nov;111(11 Pt 1):1893-5. doi: 10.1097/00005537-200111000-00003.
A previous study of 371 patients with extracapsular spread (ECS) of cervical metastases from squamous cell carcinoma (SCCA) of the head and neck revealed a survival advantage for patients treated with adjuvant chemoradiation, compared with those treated with surgery and radiation or surgery alone. While all patients in the study were offered adjuvant chemotherapy, only 35% selected this option. Comorbidity was identified as a reason for declining chemotherapy. Recently, Piccirillo demonstrated that the Modified Medical Comorbidity Index (MMCI) is a valid instrument to classify and quantify severity of comorbidity. We applied this instrument to previously reported patients with ECS to determine 1) how comorbidity affected treatment selection, 2) whether the survival advantage of adjuvant chemoradiation persisted after controlling for comorbidity, and 3) the impact of comorbidity on outcome.
This was a nonrandomized, retrospective study.
Patients in the initial study underwent resection of the primary tumor and neck dissection. Eligible patients elected to receive chemoradiation, radiation, or no further treatment. Comorbidity scores were assigned according to the MMCI. Data were analyzed according to disease-specific survival and overall survival.
The study population consisted of 330 patients. More severe comorbidity was related to higher overall mortality rates after controlling for treatment. Adjuvant chemoradiation resulted in improved disease-specific and overall survival compared with adjuvant radiation after adjusting for severity of comorbidity.
These results substantiate the benefits of adjuvant chemoradiation for patients with SCCA of the head and neck. Furthermore, these results reinforce the importance of comorbidity as a prognostic indicator for this population of patients.
先前一项针对371例头颈部鳞状细胞癌（SCCA）颈转移包膜外扩散（ECS）患者的研究显示，与接受手术和放疗或单纯手术治疗的患者相比，接受辅助放化疗的患者具有生存优势。虽然研究中的所有患者都可选择辅助化疗，但只有35%的患者选择了这一方案。合并症被确定为拒绝化疗的一个原因。最近，皮西里洛证明改良医疗合并症指数（MMCI）是一种用于分类和量化合并症严重程度的有效工具。我们将该工具应用于先前报道的ECS患者，以确定：1）合并症如何影响治疗选择；2）在控制合并症后，辅助放化疗的生存优势是否依然存在；3）合并症对预后的影响。
这是一项非随机的回顾性研究。
初始研究中的患者接受了原发肿瘤切除和颈部清扫术。符合条件的患者选择接受放化疗、放疗或不再接受进一步治疗。根据MMCI分配合并症评分。根据疾病特异性生存和总生存对数据进行分析。
研究人群包括330例患者。在控制治疗因素后，更严重的合并症与更高的总死亡率相关。在调整合并症严重程度后，与辅助放疗相比，辅助放化疗可改善疾病特异性生存和总生存。
这些结果证实了辅助放化疗对头颈部SCCA患者的益处。此外，这些结果强化了合并症作为该患者群体预后指标的重要性。
