Biostatistics and Epidemiology Department, Institut Gustave Roussy, Villejuif, France.
Radiother Oncol. 2011 Jul;100(1):33-40. doi: 10.1016/j.radonc.2011.05.036. Epub 2011 Jun 16.
The recently updated meta-analysis of chemotherapy in head and neck cancer (MACH-NC) demonstrated the benefit of the addition of chemotherapy in terms of overall survival in head and neck squamous cell carcinoma (HNSCC). The magnitude of the benefit according to tumour site is unknown as well as their potential interactions with patient or trial characteristics.
Eighty seven randomized trials performed between 1965 and 2000 were included in the present analysis. Patients were divided into four categories according to tumour location: oral cavity, oropharynx, hypopharynx and larynx. Patients with other tumour location were excluded (999, 5.7%). For each tumour location and chemotherapy timing, the logrank-test, stratified by trial, was used to compare treatments. The hazard ratios of death or relapse were calculated. Interactions between patient or trial characteristics and chemotherapy effect were studied.
Individual patient data of 16,192 patients were analysed, with a median follow-up of 5.6years. The benefit of the addition is consistent in all tumour locations, with hazard ratios between 0.87 and 0.88 (p-value of interaction=0.99). Chemotherapy benefit was higher for concomitant administration for all tumour locations, but the interaction test between chemotherapy timing and treatment effect was only significant for oropharyngeal (p<0.0001) and laryngeal tumours (p=0.05), and not for oral cavity (p=0.15) and hypopharyngeal tumours (p=0.30). The 5-year absolute benefits associated with the concomitant chemotherapy are 8.9%, 8.1%, 5.4% and 4% for oral cavity, oropharynx, larynx and hypopharynx tumours, respectively.
The benefit of the addition of chemotherapy to locoregional treatment is consistent in all tumour locations of HNSCC. The higher benefit of concomitant schedule was demonstrated only for oropharyngeal and laryngeal tumours but this may be only a consequence of a lack of power.
最近更新的头颈部癌症化疗荟萃分析（MACH-NC）显示，在头颈部鳞状细胞癌（HNSCC）的总生存方面，化疗的加入具有获益。肿瘤部位的获益程度以及它们与患者或试验特征的潜在相互作用尚不清楚。
本分析纳入了 1965 年至 2000 年间进行的 87 项随机试验。根据肿瘤位置，患者分为以下四个类别：口腔、口咽、下咽和喉。排除其他肿瘤位置的患者（999 例，占 5.7%）。对于每个肿瘤部位和化疗时机，采用对数秩检验（按试验分层）比较治疗方法。计算死亡或复发的风险比。研究了患者或试验特征与化疗效果之间的相互作用。
分析了 16192 例患者的个体患者数据，中位随访时间为 5.6 年。在所有肿瘤部位，添加化疗的获益是一致的，风险比在 0.87 至 0.88 之间（交互检验的 p 值=0.99）。对于所有肿瘤部位，同时给药的化疗获益更高，但化疗时机与治疗效果之间的交互检验仅在口咽（p<0.0001）和喉肿瘤（p=0.05）有意义，而在口腔（p=0.15）和下咽肿瘤（p=0.30）无意义。同时接受化疗的 5 年绝对获益分别为口腔癌、口咽癌、喉癌和下咽癌的 8.9%、8.1%、5.4%和 4%。
在 HNSCC 的所有肿瘤部位，局部区域治疗中添加化疗均具有获益。仅在口咽和喉肿瘤中显示出同期化疗的更高获益，但这可能仅仅是缺乏效力的结果。
