Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
J Otolaryngol Head Neck Surg. 2013 Apr 19;42(1):30. doi: 10.1186/1916-0216-42-30.
The oral cavity is the most common site for head and neck squamous cell carcinoma. Treatment of advanced stage oral cavity squamous cell carcinoma (OCSCC) has classically involved surgical resection with postoperative adjuvant radiotherapy (S-RT).Despite this aggressive dual modality therapy, the disease outcomes have remained poor. The treatment options expanded in 2004 when two international trials showed the addition of postoperative chemotherapy to radiation improved outcomes. These trials were, however not oral cavity site specific.
To assess survival outcomes of advanced OCSCC treated by differing modalities. The primary goal was to determine if the addition of postoperative chemotherapy (S-CRT) improves survival compared to other treatment regimens.
Demographic, pathologic, treatment, and survival data was obtained from patients diagnosed with OCSCC from 1998-2010 in Alberta, Canada. 222 patients were included in the final analysis from 895 OCSCC patients. Actuarial overall, disease-specific, disease-free, and metastasis-free survivals were estimated with Kaplan-Meier and Cox regression analyses. Patients were grouped by treatment.
Patients receiving S-CRT had improved overall, disease-specific, disease-free, and metastasis-free survival compared to S-RT, CRT or RT(p < 0.05). Two and five year estimated overall survival was significantly higher in the S-CRT group at 77 and 58% (p < 0.05), versus S-RT with 55 and 40% rates(p < 0.05). Results were similar for disease-specific, disease-free, and metastasis free survival with S-CRT being favoured. Patients with extracapsular spread (ECS) treated with S-CRT versus S-RT had 55% survival advantage at 5 years (p < 0.05).
This study shows that adding adjuvant chemotherapy to S-RT improves survival outcomes in advanced OCSCC, especially in patients with ECS.
口腔是头颈部鳞状细胞癌最常见的部位。晚期口腔鳞状细胞癌（OCSCC）的治疗传统上包括手术切除加术后辅助放疗（S-RT）。尽管采用了这种积极的双模式治疗，但疾病结局仍然不佳。2004 年，两项国际试验表明，在放疗的基础上加用术后化疗可改善预后，治疗选择有所扩大。然而，这些试验并非专门针对口腔部位。
评估不同治疗方式治疗晚期 OCSCC 的生存结果。主要目标是确定与其他治疗方案相比，术后化疗（S-CRT）的加入是否能提高生存率。
从加拿大艾伯塔省 1998-2010 年诊断为 OCSCC 的患者中获取人口统计学、病理学、治疗和生存数据。从 895 例 OCSCC 患者中，最终有 222 例患者纳入最终分析。采用 Kaplan-Meier 和 Cox 回归分析估计总生存率、疾病特异性生存率、无病生存率和无转移生存率。根据治疗分组。
与 S-RT、CRT 或 RT 相比，接受 S-CRT 的患者的总生存率、疾病特异性生存率、无病生存率和无转移生存率均有改善（p<0.05）。S-CRT 组的 2 年和 5 年总生存率显著高于 S-RT 组，分别为 77%和 58%（p<0.05），而 S-RT 组分别为 55%和 40%（p<0.05）。S-CRT 组在疾病特异性、无病和无转移生存率方面也有优势。接受 S-CRT 治疗的 ECS 患者的 5 年生存率比 S-RT 组高 55%（p<0.05）。
本研究表明，在 S-RT 的基础上加用辅助化疗可提高晚期 OCSCC 的生存结局，尤其是在有 ECS 的患者中。
