晚期扁桃体癌患者的三联治疗。
Triple-modality treatment in patients with advanced stage tonsil cancer.
机构信息
Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York.
Department of Veterans Affairs, New York Harbor Healthcare, New York, New York.
出版信息
Cancer. 2017 Sep 1;123(17):3269-3276. doi: 10.1002/cncr.30728. Epub 2017 Apr 25.
BACKGROUND
Concurrent chemoradiation (CCRT) and upfront surgery followed by adjuvant therapy both are recommended treatment options for patients with advanced stage squamous cell carcinoma (SCC) of the tonsil. To the authors' knowledge, the question of whether surgical-based treatments can achieve better survival compared with CCRT has never been compared in a clinical trial. The authors analyzed the National Cancer Data Base to measure the impact of different treatment modalities on overall survival (OS).
METHODS
All patients aged ≤70 years diagnosed with clinical stage III to IVB (excluding T4B) SCC of the tonsil from 1998 through 2011 were selected. Analysis was limited to patients receiving CCRT, surgery plus CCRT, or surgery followed by adjuvant radiotherapy (RT). OS was compared using the Kaplan-Meier method and log-rank test. Univariable and multivariable hazards analyses were performed to identify factors significant for survival. Propensity score matching was performed.
RESULTS
There were 16,891 patients who met the inclusion criteria. The most common treatment was CCRT (8123 patients; 48.1%), followed by surgery plus CCRT (5249; 31.1%) and surgery plus RT (3519 patients; 20.8%). Patients treated with surgery plus CCRT were found to have the highest 3-year OS rate (88.5%) followed by those treated with surgery plus RT (84%) and CCRT (74.2%) (P<.0001). In a propensity score-matched subpopulation of 4962 patients, the 3-year OS rate was 90.2% for those treated with surgery plus CCRT, 84.9% for those treated with surgery plus RT, and 82.1% for those treated with definitive CCRT (P<.0001).
CONCLUSIONS
Patients with advanced stage SCC of the tonsil who underwent surgery followed by CCRT had the greatest OS. Patients undergoing upfront surgery may avoid chemotherapy without jeopardizing survival. Triple-modality therapy may provide a survival benefit for a subset of patients with advanced stage tonsil cancer. Cancer 2017;123:3269-76. © 2017 American Cancer Society.
背景
同期放化疗（CCRT）和手术加辅助治疗都是晚期扁桃体鳞状细胞癌（SCC）患者的推荐治疗选择。据作者所知，手术治疗与 CCRT 相比是否能提高生存率的问题从未在临床试验中进行过比较。作者分析了国家癌症数据库，以评估不同治疗方式对总生存率（OS）的影响。
方法
选择 1998 年至 2011 年间诊断为临床 III 至 IVB 期（不包括 T4B）扁桃体 SCC 的所有年龄≤70 岁的患者。分析仅限于接受 CCRT、手术加 CCRT 或手术加辅助放疗（RT）的患者。使用 Kaplan-Meier 法和对数秩检验比较 OS。进行单变量和多变量风险分析以确定与生存相关的因素。进行倾向评分匹配。
结果
符合纳入标准的患者有 16891 例。最常见的治疗方法是 CCRT（8123 例；48.1%），其次是手术加 CCRT（5249 例；31.1%）和手术加 RT（3519 例；20.8%）。结果发现，接受手术加 CCRT 治疗的患者 3 年 OS 率最高（88.5%），其次是接受手术加 RT（84%）和 CCRT（74.2%）（P<.0001）。在 4962 例倾向评分匹配的亚组中，手术加 CCRT 治疗组 3 年 OS 率为 90.2%，手术加 RT 治疗组为 84.9%，CCRT 治疗组为 82.1%（P<.0001）。
结论
接受手术加 CCRT 治疗的晚期扁桃体 SCC 患者 OS 最长。接受初始手术的患者可避免化疗而不影响生存。对于晚期扁桃体癌的一部分患者，三联疗法可能会带来生存获益。癌症 2017；123：3269-76。©2017 美国癌症协会。
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