Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
JAMA Otolaryngol Head Neck Surg. 2015 Jul;141(7):593-8. doi: 10.1001/jamaoto.2015.0719.
Most patients with oral cavity squamous cell cancer (OCSCC) are initially seen at an early stage (I and II). Although patient and tumor prognostic features have been analyzed extensively, population-level data examining how variations in treatment factors impact survival are lacking to date.
To analyze associations between treatment variables and survival in stages I and II oral cavity squamous cell carcinoma.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of cases in the National Cancer Data Base. Patients diagnosed as having stage I or II OCSCC between January 1, 2003, and December 31, 2006, and treated with surgery were identified. Univariate and multivariable analyses of overall survival based on patient, disease, and treatment characteristics were conducted.
Overall survival and survival at 5 years.
In total, 6830 patients were included. Survival at 5 years was 69.7% (4760 patients). On univariate analysis, treatment factors associated with improved survival included treatment at academic or research institutions, no radiation therapy, no chemotherapy, and negative margins (P < .001 for all). Neck dissection was associated with improved survival (P = .001), reflecting pathologic restaging and elimination of patients with occult nodal disease. Patients treated at academic or research institutions were more likely to receive neck dissection and less likely to receive radiation therapy or have positive margins. On multivariable analysis, neck dissection (hazard ratio [HR], 0.85; 95% CI, 0.76-0.94; P = .003) and treatment at academic or research institutions (HR, 0.88; 95% CI, 1.01-1.26; P = .03) were associated with improved survival, whereas positive margins (HR, 1.27; 95% CI, 1.08-1.49; P = .005), insurance through Medicare (HR, 1.45; 95% CI, 1.25-1.69; P < .001) or Medicaid (HR, 1.96; 95% CI, 1.60-2.39; P < .001), and adjuvant radiation therapy (HR, 1.31; 95% CI, 1.16-1.49; P < .001) or adjuvant chemotherapy (HR, 1.34; 95% CI, 1.03-1.75; P = .03) were associated with compromised survival.
Prognostic impacts of treatment factors in early OCSCC are presented. Overall survival for early OCSCC varies with demographic and tumor characteristics but also varies with treatment and system factors, which may represent targets for improving outcomes in this disease.
大多数口腔鳞状细胞癌 (OCSCC) 患者最初处于早期 (I 期和 II 期)。尽管已经广泛分析了患者和肿瘤预后特征，但目前仍缺乏评估治疗因素变化如何影响生存的人群水平数据。
分析 I 期和 II 期口腔鳞状细胞癌治疗变量与生存之间的关联。
设计、地点和参与者：国家癌症数据库的回顾性病例研究。确定了 2003 年 1 月 1 日至 2006 年 12 月 31 日期间诊断为 I 期或 II 期 OCSCC 并接受手术治疗的病例。基于患者、疾病和治疗特征进行了总体生存的单变量和多变量分析。
总生存和 5 年生存。
共纳入 6830 例患者。5 年生存率为 69.7%(4760 例)。单因素分析显示，与生存改善相关的治疗因素包括在学术或研究机构接受治疗、无放疗、无化疗和切缘阴性 (所有 P 值均<.001)。颈清扫术与生存改善相关 (P=.001)，反映了病理分期和消除了隐匿性淋巴结疾病患者。在学术或研究机构接受治疗的患者更有可能接受颈清扫术，不太可能接受放疗或存在阳性切缘。多因素分析显示，颈清扫术 (风险比 [HR]，0.85；95%CI，0.76-0.94；P=.003) 和在学术或研究机构治疗 (HR，0.88；95%CI，1.01-1.26；P=.03) 与生存改善相关，而阳性切缘 (HR，1.27；95%CI，1.08-1.49；P=.005)、通过医疗保险 (HR，1.45；95%CI，1.25-1.69；P<.001) 或医疗补助 (HR，1.96；95%CI，1.60-2.39；P<.001) 以及辅助放疗 (HR，1.31；95%CI，1.16-1.49；P<.001) 或辅助化疗 (HR，1.34；95%CI，1.03-1.75；P=.03) 与生存受损相关。
本文介绍了口腔早期鳞癌治疗因素的预后影响。口腔早期鳞癌的总生存因人口统计学和肿瘤特征而异，但也因治疗和系统因素而异，这些因素可能是改善该疾病结局的目标。
