术后放疗与 N1 口腔和口咽鳞状细胞癌患者生存的关系。
Association of Postoperative Radiotherapy With Survival in Patients With N1 Oral Cavity and Oropharyngeal Squamous Cell Carcinoma.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
Department of Radiation Oncology, Stanford University, Palo Alto, California.
出版信息
JAMA Otolaryngol Head Neck Surg. 2016 Dec 1;142(12):1224-1230. doi: 10.1001/jamaoto.2016.3519.
IMPORTANCE
The guidelines for head and neck cancer recommend consideration of adjuvant postoperative radiotherapy (PORT) for patients with pT1N1 or pT2N1 disease in the absence of other adverse features. This recommendation was recently changed for oropharyngeal (OP) squamous cell carcinoma (SCC).
OBJECTIVE
To examine the use and outcomes of PORT for N1 OP SCC and oral cavity (OC) SCC.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study identified 1467 adult patients with OC SCC and 790 patients with OP SCC with pT1N1 or pT2N1 disease in the absence of other adverse features from the National Cancer Database from January 1, 2004, to December 31, 2013. Patients who received adjuvant chemotherapy or palliative radiotherapy or who had adverse pathologic features were excluded. Statistical analysis included χ2 tests and Cox proportional hazards regression analysis. Data were analyzed from November 10, 2015, to June 30, 2016.
MAIN OUTCOMES AND MEASURES
Overall survival.
RESULTS
Of the 1467 patients with OC SCC (842 men [57.4%]; 625 women [42.6%]; mean [SD] age, 61.3 [13.8] years), 740 (50.4%) received PORT. Of the 790 patients with OP SCC (584 men [73.9%]; 206 women [26.1%]; mean [SD] age, 58.2 [10.3] years), 449 (56.8%) received PORT. After controlling for patient demographics, pathologic characteristics, and hospital-level variables, PORT was associated with improved overall survival for patients with OC SCC (hazard ratio [HR], 0.76; 95% CI, 0.63-0.92) and OP SCC (HR, 0.62; 95% CI, 0.41-0.92) with pN1 disease without adverse features. On stratified analysis, this association persisted for patients younger than 70 years (OC SCC HR, 0.77; 95% CI, 0.61-0.97; OP SCC HR, 0.48; 95% CI, 0.31-0.75) and those with pT2 disease (OC SCC HR, 0.64; 95% CI, 0.43-0.96; OP SCC HR, 0.56; 95% CI, 0.32-0.95), but there was no association with overall survival among patients 70 years or older (OC SCC HR, 0.78; 95% CI, 0.58-1.06; OP SCC HR, 1.55; 95% CI, 0.63-3.82) and those with pT1 disease (OC SCC HR, 0.80; 95% CI, 0.60-1.07; OP SCC HR, 0.66; 95% CI, 0.35-1.24).
CONCLUSIONS AND RELEVANCE
PORT may be associated with improved survival in patients with pN1 OC and OP SCC, especially in those younger than 70 years or those with pT2 disease.
重要性
头颈部癌症指南建议对于无其他不良特征的 pT1N1 或 pT2N1 疾病的患者考虑进行辅助术后放疗 (PORT)。最近，这一建议也适用于口咽 (OP) 鳞状细胞癌 (SCC)。
目的
检查 PORT 在 N1 OP SCC 和口腔 (OC) SCC 中的使用情况和结果。
设计、地点和参与者：这项回顾性队列研究从 2004 年 1 月 1 日至 2013 年 12 月 31 日从国家癌症数据库中确定了 1467 名患有 OC SCC 和 790 名患有 pT1N1 或 pT2N1 疾病且无其他不良特征的 OP SCC 成年患者。排除接受辅助化疗或姑息性放疗或具有不良病理特征的患者。统计分析包括 χ2 检验和 Cox 比例风险回归分析。数据于 2015 年 11 月 10 日至 2016 年 6 月 30 日进行分析。
主要结果和措施
总生存率。
结果
在 1467 名 OC SCC 患者中（842 名男性 [57.4%]；625 名女性 [42.6%]；平均 [标准差]年龄为 61.3 [13.8] 岁），740 名（50.4%）接受了 PORT。在 790 名 OP SCC 患者中（584 名男性 [73.9%]；206 名女性 [26.1%]；平均 [标准差]年龄为 58.2 [10.3] 岁），449 名（56.8%）接受了 PORT。在控制了患者人口统计学特征、病理特征和医院级别变量后，PORT 与 OC SCC（风险比 [HR]，0.76；95%CI，0.63-0.92）和 OP SCC（HR，0.62；95%CI，0.41-0.92）的无不良特征的 pN1 疾病患者的总生存率提高相关。分层分析显示，这一关联在年龄小于 70 岁的患者（OC SCC HR，0.77；95%CI，0.61-0.97；OP SCC HR，0.48；95%CI，0.31-0.75）和 pT2 疾病患者中仍然存在（OC SCC HR，0.64；95%CI，0.43-0.96；OP SCC HR，0.56；95%CI，0.32-0.95），但在年龄 70 岁或以上的患者（OC SCC HR，0.78；95%CI，0.58-1.06；OP SCC HR，1.55；95%CI，0.63-3.82）和 pT1 疾病患者中与总生存率无关（OC SCC HR，0.80；95%CI，0.60-1.07；OP SCC HR，0.66；95%CI，0.35-1.24）。
结论和相关性
PORT 可能与 pN1 OC 和 OP SCC 患者的生存改善相关，尤其是在年龄小于 70 岁或 pT2 疾病患者中。
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