Graboyes Evan M, Zhan Kevin Y, Garrett-Mayer Elizabeth, Lentsch Eric J, Sharma Anand K, Day Terry A
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Cancer. 2017 Jun 15;123(12):2248-2257. doi: 10.1002/cncr.30586. Epub 2017 Feb 9.
The current study was conducted to determine the effect of postoperative radiotherapy (PORT) on overall survival in patients with surgically managed pT3-T4aN0 laryngeal squamous cell carcinoma (SCC).
A review of the National Cancer Data Base from 2004 through 2013 was performed. Patients with surgically managed pT3-4aN0 laryngeal SCC with negative surgical margins were included. Univariable and multivariable Cox regression analyses were used to determine factors associated with survival.
A total of 1460 patients were included, 46.2% of whom had pT3N0 disease (674 patients) and 53.8% of whom had pT4aN0 disease (786 patients). Approximately 72.0% of the patients with pT3N0 disease (485 patients) and 50.1% of the patients with pT4aN0 disease (394 patients) received PORT. PORT was not found to be associated with improved overall survival on univariable analysis for patients with pT3N0 disease (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.62-1.14), but was for patients with pT4aN0 disease (HR, 0.57; 95% CI, 0.45-0.71). For patients with pT3N0 SCC of the larynx, in a multivariable Cox regression analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, extent of laryngectomy, and number of lymph nodes removed, PORT was not found to be associated with improved survival (adjusted HR, 0.88; 95% CI, 0.64-1.21). For patients with pT4aN0 disease, the administration of PORT was associated with improved survival on multivariable analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, number of lymph nodes removed, and type of hospital (adjusted HR, 0.58; 95% CI, 0.46-0.73).
For patients with surgically managed pT3N0 laryngeal SCC with negative margins, PORT does not appear to be associated with improved survival. Despite a survival benefit, nearly 50% of patients with pT4aN0 laryngeal SCC and negative surgical margins do not receive standard-of-care PORT. Cancer 2017;123:2248-2257. © 2017 American Cancer Society.
本研究旨在确定术后放疗（PORT）对手术治疗的pT3 - T4aN0喉鳞状细胞癌（SCC）患者总生存期的影响。
对2004年至2013年的国家癌症数据库进行回顾性研究。纳入手术治疗且手术切缘阴性的pT3 - 4aN0喉SCC患者。采用单因素和多因素Cox回归分析确定与生存相关的因素。
共纳入1460例患者，其中46.2%为pT3N0期疾病（674例患者），53.8%为pT4aN0期疾病（786例患者）。pT3N0期疾病患者中约72.0%（485例患者）和pT4aN0期疾病患者中50.1%（394例患者）接受了PORT。在对pT3N0期疾病患者的单因素分析中，未发现PORT与总生存期改善相关（风险比[HR]，0.84；95%置信区间[95%CI]，0.62 - 1.14），但在pT4aN0期疾病患者中相关（HR，0.57；95%CI，0.45 - 0.71）。对于pT3N0期喉SCC患者，在多因素Cox回归分析中，校正年龄>65岁、合并症严重程度、喉亚部位、喉切除术范围和切除淋巴结数量后，未发现PORT与生存期改善相关（校正HR，0.88；95%CI，0.64 - 1.21）。对于pT4aN0期疾病患者，在多因素分析中校正年龄>65岁、合并症严重程度、喉亚部位、切除淋巴结数量和医院类型后，PORT与生存期改善相关（校正HR，0.58；95%CI，0.46 - 0.73）。
对于手术切缘阴性的pT3N0期喉SCC患者，PORT似乎与生存期改善无关。尽管有生存获益，但近50%手术切缘阴性的pT4aN0期喉SCC患者未接受标准治疗的PORT。《癌症》2017年；123：2248 - 2257。©2017美国癌症协会。
