Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
Comprehensive Cancer Center Biostatistics Unit, University of Michigan, Ann Arbor.
JAMA Otolaryngol Head Neck Surg. 2014 Feb;140(2):134-42. doi: 10.1001/jamaoto.2013.5892.
The University of Michigan has investigated the use of induction selection (IS) with chemoradiotherapy (CRT) for patients who respond to CRT and found this approach effective in the management of advanced laryngeal cancer. The IS approach was extended to oral cavity squamous cell carcinoma (OCSCC) to help understand whether organ preservation or survival benefit resulted.
To evaluate the efficacy of an IS protocol vs primary surgical extirpation and selective postoperative radiotherapy for advanced OCSCC.
Retrospective matched cohort study at a tertiary care hospital.
Nineteen patients with resectable stages III and IV OCSCC were enrolled into a phase 2 IS trial. Patients with a response of at least 50% underwent concurrent CRT; those with a response of less than 50% underwent surgical treatment and radiotherapy. A comparison cohort of patients treated with primary surgical extirpation during a similar time period was frequency matched for inclusion criteria and patient characteristics to those patients included from the phase 2 IS trial. No difference was noted in age, sex, pretreatment American Joint Committee on Cancer stage, T and N classifications, smoking status, alcohol consumption, or tumor subsite between the IS and surgical cohorts. Median follow-up was 9.4 years in the IS cohort and 7.1 years in the surgical cohort.
Induction selection and CRT vs primary surgical extirpation with or without postoperative radiotherapy.
Overall and disease-specific survival and locoregional control.
The Kaplan-Meier estimate for overall survival at 5 years was 32% in the IS cohort and 65% in the surgical cohort. The Kaplan-Meier estimate for disease-specific survival at 5 years was 46% in the IS cohort and 75% in the surgical cohort. The Kaplan-Meier estimate for locoregional control at 5 years was 26% in the IS cohort and 72% in the surgical cohort. Multivariable analysis demonstrated significantly better overall and disease-specific survival and locoregional control outcomes (P = .03, P = .001, and P < .001, respectively) in the surgical cohort.
Primary surgical treatment showed significantly better survival and locoregional control compared with IS in this matched patient cohort. Despite success of organ preservation IS protocols in the larynx, comparative survival analysis of an IS protocol vs primary surgical extirpation for OCSCC demonstrates significantly better outcomes in the surgical cohort. These findings support surgery as the principal treatment for OCSCC.
密歇根大学研究了诱导选择（IS）联合放化疗（CRT）在对 CRT 有反应的患者中的应用，发现这种方法在治疗晚期喉癌方面非常有效。该 IS 方法被扩展到口腔鳞状细胞癌（OCSCC），以帮助了解是否有器官保存或生存获益。
评估 IS 方案与原发手术切除和选择性术后放疗治疗晚期 OCSCC 的疗效。
在一家三级护理医院进行回顾性匹配队列研究。
19 名可切除的 III 期和 IV 期 OCSCC 患者参加了一项 2 期 IS 试验。对至少 50%反应的患者进行同步 CRT；对反应小于 50%的患者进行手术治疗和放疗。在相似的时间段内，通过纳入标准和患者特征与从 2 期 IS 试验中纳入的患者进行频率匹配，建立了接受原发手术切除治疗的比较队列。在 IS 组和手术组之间，年龄、性别、治疗前美国癌症联合委员会分期、T 和 N 分类、吸烟状况、饮酒状况或肿瘤亚部位无差异。IS 组的中位随访时间为 9.4 年，手术组为 7.1 年。
诱导选择和 CRT 与原发手术切除联合或不联合术后放疗。
总生存率、疾病特异性生存率和局部区域控制率。
IS 组 5 年总生存率的 Kaplan-Meier 估计值为 32%，手术组为 65%。IS 组 5 年疾病特异性生存率的 Kaplan-Meier 估计值为 46%，手术组为 75%。IS 组 5 年局部区域控制率的 Kaplan-Meier 估计值为 26%，手术组为 72%。多变量分析显示，手术组的总生存率、疾病特异性生存率和局部区域控制率明显更好（P = .03、P = .001 和 P < .001）。
在本匹配患者队列中，与 IS 相比，原发手术治疗的总生存率和局部区域控制率明显更好。尽管 IS 方案在保留器官方面取得了成功，但对 IS 方案与原发手术切除治疗 OCSCC 的生存分析表明，手术组的生存结果明显更好。这些发现支持手术作为 OCSCC 的主要治疗方法。
