Pollom Erqi L, Chin Alexander L, Lee Nancy Y, Tsai C Jillian
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):758-766. doi: 10.1016/j.ijrobp.2017.01.224. Epub 2017 Feb 2.
To characterize the patterns of care and potential barriers to access to care for elderly patients with oral cavity cancer in the adjuvant setting.
We performed a retrospective cohort study using the National Cancer Data Base and identified patients with resected oral cavity squamous cell carcinoma diagnosed between 2004 and 2012, who survived for ≥3 months after surgery. We used logistic regression models to assess the association between age (<70, 70-79, and ≥80 years) and the receipt of adjuvant therapy within 3 months of surgery. We additionally assessed the association between patient and tumor characteristics and the receipt of adjuvant therapy among those aged ≥70 years.
A total of 25,829 patients were included in the study. Compared with those aged <70 years, older patients were more likely to have no neck dissection or have fewer lymph nodes dissected and were less likely to receive adjuvant therapy than younger patients. Among our cohort, 11,361 patients (44%) had pathologic T3-T4 disease or N2-N3 disease, and 4185 patients (16%) had extracapsular nodal extension or positive surgical margins. In multivariate analyses controlling for comorbidity and demographic characteristics, older age was independently associated with lower odds of receiving adjuvant radiation therapy in the subgroup with T3 or T4 disease or N2 or N3 disease and adjuvant chemoradiation therapy in the positive extracapsular nodal extension or positive surgical margin subgroup. Among elderly patients, both greater patient distance from reporting facility and older age were associated with lower odds of receiving both adjuvant radiation therapy (odds ratio 0.66; 95% confidence interval, 0.55-0.81) and chemoradiation therapy (odds ratio 0.56; 95% confidence interval, 0.40-0.79).
In a national hospital-based cohort of patients with oral cavity cancer, elderly patients were less likely to receive adjuvant radiation or chemoradiation therapy. Greater patient distance from reporting facility, in addition to older age, was associated with lower odds of receiving both adjuvant radiation therapy and adjuvant chemoradiation therapy.
描述辅助治疗环境下老年口腔癌患者的护理模式及获得护理的潜在障碍。
我们使用国家癌症数据库进行了一项回顾性队列研究，确定了2004年至2012年间诊断为口腔鳞状细胞癌且术后存活≥3个月的患者。我们使用逻辑回归模型评估年龄（<70岁、70 - 79岁和≥80岁）与术后3个月内接受辅助治疗之间的关联。我们还评估了患者和肿瘤特征与70岁及以上患者接受辅助治疗之间的关联。
共有25829名患者纳入研究。与<70岁的患者相比，老年患者更有可能未进行颈部清扫或清扫的淋巴结较少，且比年轻患者接受辅助治疗的可能性更小。在我们的队列中，11361名患者（44%）患有病理T3 - T4期疾病或N2 - N3期疾病，4185名患者（16%）有包膜外淋巴结转移或手术切缘阳性。在控制合并症和人口统计学特征的多变量分析中，在T3或T4期疾病或N2或N3期疾病亚组中，年龄较大与接受辅助放疗的几率较低独立相关；在包膜外淋巴结转移阳性或手术切缘阳性亚组中，年龄较大与接受辅助放化疗的几率较低独立相关。在老年患者中，患者与报告机构的距离较远以及年龄较大均与接受辅助放疗（比值比0.66；95%置信区间，0.55 - 0.81）和放化疗（比值比0.56；95%置信区间，0.40 - 0.79）的几率较低相关。
在一个以医院为基础的全国口腔癌患者队列中，老年患者接受辅助放疗或放化疗的可能性较小。除年龄较大外，患者与报告机构的距离较远与接受辅助放疗和辅助放化疗的几率较低相关。
