Al-Gilani Maha, Skillington S Andrew, Kallogjeri Dorina, Haughey Bruce, Piccirillo Jay F
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri2Department of Surgery, University of Auckland, Auckland, New Zealand.
JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):940-946. doi: 10.1001/jamaoto.2016.1609.
Further investigation is needed in the outcomes of currently available treatment for T3 glottic squamous cell carcinoma (SCC), a unique type of laryngeal cancer.
To compare overall survival (OS) and functional outcomes among patients with T3 glottic SCC receiving nonsurgical and surgical management.
DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis used data from the Surveillance, Epidemiology, and End Results (SEER) registry and Medicare databases. All patients with T3 glottic SCC who received a diagnosis from January 1, 1992, to December 31, 2010, were included. Data were analyzed from April 2014 to August 2015.
Surgery with or without adjuvant radiotherapy and/or chemotherapy.
Five-year OS and functional outcomes.
Among the 487 patients identified with T3 glottic SCC (418 men [85.8%]; 69 women [14.2%]; median age, 74.3 [interquartile range, 70.4-80.6] years), the 5-year OS for nonsurgical management, surgery alone, and surgery plus adjuvant treatment were 36% (95% CI, 30%-42%), 41% (95% CI, 30%-53%), and 41% (95% CI, 32%-51%), respectively. Multivariable analyses revealed an adjusted hazard ratio for OS of 0.68 (95% CI, 0.49-0.94) for patients receiving surgery alone vs nonsurgical management and 0.75 (95% CI, 0.57-0.98) for patients receiving surgery plus adjuvant treatment vs nonsurgical management. Gastrostomy tube dependence was highest in patients receiving surgery plus adjuvant treatment (30 of 98 patients [30.6%]). Tracheostomy dependence was highest in patients receiving chemoradiotherapy (34 of 92 patients [37.0%]).
Overall survival showed a statistically significant and clinically meaningful improvement in patients with T3 glottic SCC who underwent surgery compared with a nonsurgical treatment. Furthermore, the data suggest that adjuvant and nonsurgical treatment result in a dysfunctional larynx; however, this association needs further study.
对于T3声门型鳞状细胞癌（SCC）这种独特类型的喉癌，目前可用治疗方法的疗效仍需进一步研究。
比较接受非手术和手术治疗的T3声门型SCC患者的总生存期（OS）和功能结局。
设计、设置和参与者：这项二次分析使用了监测、流行病学和最终结果（SEER）登记处以及医疗保险数据库的数据。纳入了所有在1992年1月1日至2010年12月31日期间被诊断为T3声门型SCC的患者。数据于2014年4月至2015年8月进行分析。
手术联合或不联合辅助放疗和/或化疗。
五年总生存期和功能结局。
在487例确诊为T3声门型SCC的患者中（418例男性[85.8%]；69例女性[14.2%]；中位年龄74.3岁[四分位间距，70.4 - 80.6岁]），非手术治疗、单纯手术以及手术加辅助治疗的5年总生存期分别为36%（95%置信区间，30% - 42%）、41%（95%置信区间，30% - 53%）和41%（95%置信区间，32% - 51%）。多变量分析显示，单纯手术治疗的患者与非手术治疗相比，总生存期的调整风险比为0.68（95%置信区间，0.49 - 0.94）；手术加辅助治疗的患者与非手术治疗相比，总生存期的调整风险比为0.75（95%置信区间，0.57 - 0.98）。接受手术加辅助治疗的患者胃造瘘管依赖率最高（98例患者中有30例[30.6%]）。接受放化疗的患者气管造口依赖率最高（92例患者中有34例[37.0%]）。
与非手术治疗相比，接受手术的T3声门型SCC患者的总生存期在统计学上有显著且具有临床意义的改善。此外，数据表明辅助治疗和非手术治疗会导致喉部功能障碍；然而，这种关联需要进一步研究。
