Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7070, USA.
Laryngoscope. 2011 Sep;121(9):1881-7. doi: 10.1002/lary.21968.
OBJECTIVES/HYPOTHESIS: Although treatment paradigms have shifted to recommend primary chemoradiation therapy (CRT) for advanced head and neck squamous cell carcinoma, few studies include any significant number of patients with N3 (>6 cm) neck disease. The objective of this study was to determine if primary chemoradiation therapy has equivalent overall survival (OS) and disease-free survival (DFS) when compared to primary surgical resection in patients with N3 neck disease.
Nonrandomized, single-institution, retrospective cohort study.
Retrospective analysis of 100 patients treated for HNSCC with N3 neck disease between 1989 and 2009 was performed.
Patients who received primary surgery had better OS and DFS than those who had primary chemoradiation (P = .047), with a 5-year OS of 68% (95% confidence interval [CI], 45%-84%) versus 32% (95% CI, 19%-45%), and a 5-year DFS of 64% (95% CI, 41%-80%) versus 32% (95% CI, 19%-45%). Neck dissection following primary treatment with CRT did not improve OS. For patients with nonoropharyngeal squamous cell carcinoma with N3 neck disease, those who underwent primary surgery (n = 14) had significantly better OS than those who had primary CRT (n = 32, P = .02). Patients with oropharyngeal disease had better outcomes than other sites regardless of treatment modality, with 5-year OS of 54% (95% CI, 38%-68%) versus 32% (95% CI, 17%-47%, P = .02), but there was no statistical difference between patients treated with primary surgery versus CRT.
Patients with head and neck squamous cell cancer and N3 neck disease have at least equivalent survival with primary surgical treatment versus primary CRT. Primary surgical resection with appropriate adjuvant therapy should be considered for patients with resectable N3 disease, especially patients with nonoropharyngeal sites. Post-CRT neck dissections did not change the OS of patients with N3 disease.
目的/假设：尽管治疗模式已经转变为推荐对晚期头颈部鳞状细胞癌进行原发放化疗（CRT），但很少有研究包括大量 N3（>6cm）颈部疾病患者。本研究的目的是确定与原发手术切除相比，原发放化疗在 N3 颈部疾病患者中的总生存期（OS）和无病生存期（DFS）是否相当。
非随机、单机构、回顾性队列研究。
对 1989 年至 2009 年间 100 例接受 N3 颈部疾病治疗的头颈部鳞状细胞癌患者进行回顾性分析。
接受原发手术的患者 OS 和 DFS 均优于接受原发放化疗的患者（P=0.047），5 年 OS 为 68%（95%置信区间[CI]，45%-84%），而 5 年 DFS 为 64%（95%CI，41%-80%），5 年 OS 为 32%（95%CI，19%-45%）。CRT 后行颈部清扫术并不能提高 OS。对于非口咽鳞状细胞癌伴 N3 颈部疾病的患者，行原发手术（n=14）的患者 OS 明显优于行原发 CRT（n=32，P=0.02）。无论治疗方式如何，口咽疾病患者的预后均优于其他部位，5 年 OS 为 54%（95%CI，38%-68%），而 32%（95%CI，17%-47%，P=0.02），但原发手术与 CRT 患者之间无统计学差异。
头颈部鳞状细胞癌伴 N3 颈部疾病患者，原发手术治疗与原发 CRT 的生存结果至少相当。对于可切除的 N3 疾病患者，尤其是非口咽部位的患者，应考虑行原发手术切除联合适当的辅助治疗。CRT 后行颈部清扫术并不能改变 N3 疾病患者的 OS。
