O'Neill Caitriona B, O'Neill James P, Atoria Coral L, Baxi Shrujal S, Henman Martin C, Ganly Ian, Elkin Elena B
Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, Ireland; School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin, Ireland.
Laryngoscope. 2014 Dec;124(12):2707-13. doi: 10.1002/lary.24658. Epub 2014 Oct 4.
OBJECTIVES/HYPOTHESIS: Primary curative treatment of advanced laryngeal cancer may include surgery or chemoradiation, although recommendations vary and both are associated with complications. We evaluated predictors and trends in the use of these modalities and compared rates of complications and overall survival in a population-based cohort of older adults.
Retrospective population-based cohort study.
Using Surveillance Epidemiology and End Results (SEER) cancer registry data linked with Medicare claims, we identified patients over 65 with advanced laryngeal cancer diagnosed 1999 to 2007 who had total laryngectomy (TL) or chemoradiation (CTRT) within 6 months following diagnosis. We identified complications and estimated the impact of treatment on overall survival, using propensity score methods.
The proportion of patients receiving TL declined from 74% in 1999 to 26% in 2007 (P < 0.0001). Almost 20% of the CTRT patients had a tracheostomy following treatment, and 57% had a feeding tube. TL was associated with an 18% lower risk of death, adjusting for patient and disease characteristics. The benefit of TL was greatest in patients with the highest propensity to receive surgery.
TL remains an important treatment option in well selected older patients. However, treatment selection is complex; and factors such as functional status, patient preference, surgeon expertise, and post-treatment support services should play a role in treatment decisions.
2b. Laryngoscope, 124:2707-2713, 2014.
目的/假设：晚期喉癌的主要根治性治疗方法可能包括手术或放化疗，尽管相关建议存在差异，且两种方法都伴有并发症。我们评估了这些治疗方式使用情况的预测因素和趋势，并比较了基于人群队列的老年患者的并发症发生率和总生存率。
基于人群的回顾性队列研究。
利用与医疗保险索赔数据相链接的监测、流行病学和最终结果（SEER）癌症登记数据，我们确定了1999年至2007年诊断为晚期喉癌且在诊断后6个月内接受全喉切除术（TL）或放化疗（CTRT）的65岁以上患者。我们确定了并发症，并使用倾向评分方法估计了治疗对总生存率的影响。
接受TL治疗的患者比例从1999年的74%降至2007年的26%（P < 0.0001）。近20%的CTRT患者在治疗后进行了气管造口术，57%的患者使用了饲管。在对患者和疾病特征进行调整后，TL与死亡风险降低18%相关。TL的益处对于接受手术倾向最高的患者最为显著。
对于精心挑选的老年患者，TL仍然是一种重要的治疗选择。然而，治疗选择很复杂；功能状态、患者偏好、外科医生专业知识和治疗后支持服务等因素应在治疗决策中发挥作用。
2b。《喉镜》，124:2707 - 2713，2014年。
