Langendijk J A, de Jong M A, Leemans C R, de Bree R, Smeele L E, Doornaert P, Slotman B J
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2003 Nov 1;57(3):693-700. doi: 10.1016/s0360-3016(03)00624-2.
To test the hypothesis that (1) the distinction between intermediate- and high-risk patients by clustering different prognostic factors results in a significant difference in treatment outcome and (2) a shorter interval between surgery and radiotherapy and shorter overall treatment times of radiation (OTTRT) result in higher rates of locoregional control (LRC).
Included were patients (n = 217) with previously untreated squamous cell carcinoma of the oral cavity treated with radical surgery and postoperative radiotherapy. Patients with extranodal spread or microscopic residual disease and patients with two or more other risk factors (i.e., N2b-N3, >1 nodal level involved, perineural growth, or stage T3-T4) were classified as high-risk patients. Patients with only one other risk factor were classified as intermediate risk.
In the intermediate-risk group, the 3-year LRC was 87% as compared with 66% in the high-risk group (p = 0.0005). No association was found between interval and LRC. However, the OTTRT was significantly associated with LRC. The 3-year LRC was 87%, 75%, 69%, and 51% when the OTT was <6 weeks, 6-7 weeks, 7-8 weeks, and >8 weeks, respectively (p = 0.0004). The 3-year overall survival (OS) in the intermediate risk patients was 74% compared with 50% in the high-risk group (p = 0.0014). A significant association was also found between the OS and OTTRT. The OS increased from 50% when the OTTRT was >8 weeks to 74% when the OTT was <6 weeks (p = 0.006). Similar results were found with regard to the disease-free survival (DFS). In the multivariate analysis, both risk group and OTT were significantly associated with LRC, DFS, and OS. No significant interaction term was present between these two factors, which means that the OTT was of importance both for the high-risk and the intermediate-risk patients.
In the subset of patients with carcinoma of the oral cavity, the classification of high- and intermediate-risk patients by clustering a number of prognostic factors provides important prognostic information regarding LRC, DFS, and OS. The OTT was the most important prognostic factor both in the high-risk and intermediate-risk patients. Reducing the OTT to 6 weeks or less is a rather simple measure to achieve a considerable improvement of the outcome of treatment in this category of patients.
检验以下假设：（1）通过对不同预后因素进行聚类分析来区分中危和高危患者，会导致治疗结果出现显著差异；（2）手术与放疗之间的间隔时间较短以及放疗总治疗时间（OTTRT）较短会导致局部区域控制（LRC）率更高。
纳入217例先前未经治疗的口腔鳞状细胞癌患者，这些患者接受了根治性手术和术后放疗。有结外扩散或微小残留病灶的患者以及有两个或更多其他危险因素（即N2b - N3、累及一个以上淋巴结区域、神经周围浸润或T3 - T4期）的患者被分类为高危患者。仅有一个其他危险因素的患者被分类为中危患者。
在中危组中，3年局部区域控制率为87%，而高危组为66%（p = 0.0005）。未发现间隔时间与局部区域控制之间存在关联。然而，放疗总治疗时间与局部区域控制显著相关。当放疗总治疗时间<6周、6 - 7周、7 - 8周和>8周时，3年局部区域控制率分别为87%、75%、69%和51%（p = 0.0004）。中危患者的3年总生存率为74%，而高危组为50%（p = 0.0014）。总生存率与放疗总治疗时间之间也发现了显著关联。当放疗总治疗时间>8周时总生存率为50%，当放疗总治疗时间<6周时增至74%（p = 0.006）。无病生存率（DFS）也得到了类似结果。在多变量分析中，风险组和放疗总治疗时间均与局部区域控制、无病生存率和总生存率显著相关。这两个因素之间不存在显著的交互项，这意味着放疗总治疗时间对高危和中危患者都很重要。
在口腔癌患者亚组中，通过对多个预后因素进行聚类分析来对高危和中危患者进行分类，可提供有关局部区域控制、无病生存率和总生存率的重要预后信息。放疗总治疗时间在高危和中危患者中都是最重要的预后因素。将放疗总治疗时间缩短至6周或更短是在这类患者中实现治疗结果显著改善的一个相当简单的措施。
