Department of Radiotherapy, Centre Antoine-Lacassagne, Nice, France.
Radiother Oncol. 2009 Dec;93(3):516-23. doi: 10.1016/j.radonc.2009.07.015. Epub 2009 Aug 21.
We report the experience of two French cancer centers in the treatment of oral cavity squamous cell carcinoma (SCC) in patients aged 80 years.
Two hundred and sixty patients aged 80 years with a primary oral cavity SCC were included in this retrospective analysis.
Sex ratio was near to 1. Tobacco or alcohol intoxication was the main risk factor for 66% of men and 16% of women and leukoplakia, lichen planus, or oral traumatism for 55% of women and 11% of men (p<0.0001). Two hundred patients received a loco-regional (LR) treatment with a curative intent (surgery and/or radiotherapy), 29 with a palliative intent and 31 did not receive a LR treatment. Curative treatments were initially planned to be adapted to age in 118 patients (59%). The median disease-specific survival (DSS) was 29 months. In multivariate analysis, the independent prognostic factors for DSS were stage (HR=0.42 [0.24-0.72]), age (HR=0.43 [0.24-0.75]) and performance status (HR=0.50 [0.27-0.95]). The median overall survival (OS) was 14 months. In multivariate analysis, the independent prognostic factors for OS were age (HR=0.52 [0.35-0.79]), stage (HR=0.56 [0.38-0.84]), tumor differentiation (HR=0.60 [0.33-0.93]) and performance status (HR=0.6 [0.37-0.97]). In patients treated with a curative intent, treatment adapted to age was not associated with a decreased overall survival or disease-specific survival as compared with the standard treatment. However, prophylactic lymph node treatment in stages I-II tumors decreased the rate of nodal recurrence from 38% to 6% (p=0.01).
This study emphasizes the need for prospective evaluation of standard and adapted schedules in elderly patients with oral cavity cancer.
我们报告了法国两个癌症中心在治疗 80 岁以上口腔鳞状细胞癌（SCC）患者方面的经验。
这项回顾性分析纳入了 260 名年龄在 80 岁的原发性口腔 SCC 患者。
男女比例接近 1:1。66%的男性和 16%的女性主要的风险因素是烟草或酒精中毒，55%的女性和 11%的男性主要的风险因素是口腔白斑病、扁平苔藓或口腔创伤（p<0.0001）。200 名患者接受了以治愈为目的的局部区域（LR）治疗（手术和/或放疗），29 名患者接受了姑息性治疗，31 名患者未接受 LR 治疗。118 名患者（59%）最初计划根据年龄调整治疗方案。疾病特异性生存（DSS）的中位数为 29 个月。多因素分析显示，DSS 的独立预后因素为分期（HR=0.42[0.24-0.72]）、年龄（HR=0.43[0.24-0.75]）和体能状态（HR=0.50[0.27-0.95]）。总生存（OS）的中位数为 14 个月。多因素分析显示，OS 的独立预后因素为年龄（HR=0.52[0.35-0.79]）、分期（HR=0.56[0.38-0.84]）、肿瘤分化（HR=0.60[0.33-0.93]）和体能状态（HR=0.6[0.37-0.97]）。在接受治愈性治疗的患者中，与标准治疗相比，根据年龄调整治疗方案并不与总生存或疾病特异性生存降低相关。然而，I-II 期肿瘤的预防性淋巴结治疗将淋巴结复发率从 38%降至 6%（p=0.01）。
这项研究强调需要前瞻性评估老年口腔癌患者的标准和适应性治疗方案。
