George Jonathan R, Yom Sue S, Wang Steven J
Department of Otolaryngology-Head & Neck Surgery, School of Medicine, University of California, San Francisco, San Francisco, California, U.S.A.
Laryngoscope. 2014 Jul;124(7):1603-8. doi: 10.1002/lary.24552. Epub 2014 Feb 6.
OBJECTIVES/HYPOTHESIS: Our objective was to evaluate for outcomes differences for patients with oral cavity squamous cell carcinoma (OCSCC) who underwent primary surgical resection at an academic center (AC), followed by postoperative radiation therapy either at the AC or at a nonacademic radiation treatment center (non-AC).
Secondary analysis of a retrospective cohort of patients with previously untreated upper aerodigestive tract SCC who underwent surgery followed by adjuvant therapy at an AC from 2002 to 2012. Fifty-three matched pairs of OCSCC patients surgically treated at the AC, but receiving adjuvant radiation at either an AC or a non-AC, were evaluated for differences in clinicopathologic variables, radiation treatment metrics, and survival outcomes. The main outcome measures were overall survival, disease-specific survival, and locoregional control rates.
Matched pairs were closely comparable in TNM (tumor, node, metastasis) stage, age, and gender. There were no significant between-groups differences in demographic and clinicopathologic variables except for smoking status (never smokers 43.3% for AC vs. 20.8% for non-AC; P=0.037). Non-AC OCSCC patients received a significantly lower total radiation dose (P=0.0004) and lower radiation fractional dose (P=0.0002) than their AC matched-pair counterparts. AC treatment was associated with improved overall survival (P=0.005), disease-specific survival (P=0.019), and locoregional control (P=0.016). AC treatment was an independent predictor of overall survival on multivariate analysis (P=0.044), after adjustment for clinicopathologic differences between groups.
Improved survival for combined modality treatment of OCSCC at the AC was noted on multivariate analysis. Differences in key radiation treatment metrics could explain survival differences noted in this study.
目的/假设：我们的目的是评估在学术中心（AC）接受原发性手术切除，随后在AC或非学术性放射治疗中心（非AC）接受术后放射治疗的口腔鳞状细胞癌（OCSCC）患者的预后差异。
对2002年至2012年在AC接受手术及辅助治疗的既往未经治疗的上消化道鳞状细胞癌患者的回顾性队列进行二次分析。评估了53对在AC接受手术治疗，但在AC或非AC接受辅助放疗的OCSCC患者在临床病理变量、放射治疗指标和生存结局方面的差异。主要结局指标为总生存率、疾病特异性生存率和局部区域控制率。
配对组在TNM（肿瘤、淋巴结、转移）分期、年龄和性别方面密切可比。除吸烟状况外，人口统计学和临床病理变量在组间无显著差异（AC组从不吸烟者为43.3%，非AC组为20.8%；P = 0.037）。非AC的OCSCC患者比其在AC的配对组患者接受的总放射剂量显著更低（P = 0.0004），放射分次剂量也更低（P = 0.0002）。AC治疗与改善总生存率（P = 0.005）、疾病特异性生存率（P = 0.019）和局部区域控制（P = 0.016）相关。在对组间临床病理差异进行调整后，多因素分析显示AC治疗是总生存率的独立预测因素（P = 0.044）。
多因素分析显示，在AC对OCSCC进行综合治疗可提高生存率。关键放射治疗指标的差异可以解释本研究中观察到的生存差异。
4级。
