Roden Dylan F, Schreiber David, Givi Babak
1 Department of Otolaryngology-Head and Neck Surgery, New York University, New York, NY, USA.
2 Department of Veterans Affairs, New York Harbor Campus, Brooklyn, New York, USA.
Otolaryngol Head Neck Surg. 2017 Jul;157(1):62-68. doi: 10.1177/0194599817696290. Epub 2017 Mar 7.
Objective Compare survival outcomes between unimodality and multimodality treatments for early-stage tonsil squamous cell carcinoma (SCC). Study Design and Setting Review of the National Cancer Database. Subjects and Methods Patients were selected if they were <70 years old with clinical stage I-II SCC of the tonsil, as documented in the National Cancer Database from 1998 to 2011. Palliative and nonstandard treatments were excluded. Propensity score matching was performed, controlling for tumor stage, age, race, comorbidity, insurance status, and year of diagnosis. Overall survival (OS) was compared with the Kaplan-Meier method and log-rank test. Results We identified 3247 patients. Radiotherapy (RT) was delivered in 1295 patients (39.9%), surgery in 824 (25.4%), and surgery + RT in 1128 (34.7%). Patients treated with surgery + RT had the highest 5-year OS (81.1%), followed by surgery (67.4%) and RT (63.4%; P < .001). In a propensity score-matched subpopulation of 2378 patients, the 5-year OS was 78.8% for surgery + RT, 66.7% for surgery, and 64.5% for RT ( P < .001). Among patients who underwent surgical tonsillectomy plus elective neck dissection and/or adjuvant RT, the 5-year OS was equal ( P = .29), and all were superior to RT alone ( P < .001). Conclusion Multimodality treatment is associated with the greatest survival in early-stage tonsil cancer. The addition of tonsillectomy to RT confers a 20% increase in survival. The current guidelines might not offer the most effective treatment. An up-front surgical approach, followed by appropriately selected adjuvant therapy, may result in improved survival for early-stage tonsil SCC. These findings merit investigation in a prospective clinical trial.
目的 比较早期扁桃体鳞状细胞癌（SCC）单模态和多模态治疗的生存结果。研究设计与背景 对国家癌症数据库进行回顾。对象与方法 入选1998年至2011年国家癌症数据库中记录的年龄<70岁、扁桃体临床I-II期SCC患者。排除姑息性和非标准治疗。进行倾向评分匹配，控制肿瘤分期、年龄、种族、合并症、保险状况和诊断年份。采用Kaplan-Meier法和对数秩检验比较总生存期（OS）。结果 共识别出3247例患者。1295例（39.9%）接受放射治疗（RT），824例（25.4%）接受手术治疗，1128例（34.7%）接受手术+RT治疗。接受手术+RT治疗的患者5年OS最高（81.1%），其次是手术（67.4%）和RT（63.4%；P<.001）。在2378例倾向评分匹配的亚组患者中，手术+RT的5年OS为78.8%，手术为66.7%，RT为64.5%（P<.001）。在接受扁桃体切除加选择性颈清扫和/或辅助RT的患者中，5年OS相等（P=.29），且均优于单纯RT（P<.001）。结论 多模态治疗与早期扁桃体癌的最大生存率相关。RT联合扁桃体切除术可使生存率提高20%。当前指南可能未提供最有效的治疗方法。先行手术治疗，随后选择合适的辅助治疗，可能会提高早期扁桃体SCC的生存率。这些发现值得在前瞻性临床试验中进行研究。
