Bakst Richard L, Su William, Ozbek Umut, Knoll Miriam A, Miles Brett A, Gupta Vishal, Rhome Ryan
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Icahn School of Medicine at Mount Sinai, New York, New York.
Adv Radiat Oncol. 2017 Apr 6;2(2):159-166. doi: 10.1016/j.adro.2017.03.008. eCollection 2017 Apr-Jun.
There are no randomized data to support the use of postoperative radiation for salivary gland malignancies. This study uses the National Cancer Database (NCDB) to describe the epidemiology of salivary gland cancer patients and to investigate whether treatment with adjuvant radiation improves overall survival.
A total of 8243 patients diagnosed with a major salivary gland cancer were identified from the NCDB. All patients received primary surgical resection of their malignancy. Patients were risk-stratified by adverse features, and overall survival rates were determined. Patients were considered high risk if they had extracapsular extension and/or positive margin after resection. Patients were considered intermediate risk if they did not meet the criteria for high risk but had pT3-T4 disease, pN+ disease, lymphovascular space invasion, adenoid cystic histology, or grade 2-3 disease. Patients who did not meet criteria for high or intermediate risk were considered low risk. Overall patient demographics, disease characteristics, treatment factors, and outcomes were summarized with descriptive statistics and analyzed with STATA.
Median follow-up in this cohort was 42.4 months, with the median age of 58 years. Patients in the high-risk group had greater survival (hazard ratio [HR], 0.76; = .002; 95% confidence interval [CI], 0.64-0.91) if they received adjuvant radiation therapy. In contrast, patients in the intermediate- (HR, 1.01; = .904; 95% CI, 0.85-1.20) and low-risk groups (HR, 0.85; = .427; 95% CI, 0.57-1.26) did not experience a survival benefit with adjuvant radiation therapy.
This large analysis compared survival outcomes between observation and adjuvant radiation alone in risk-stratified patients after resection of major salivary glands using a national database. The use of adjuvant radiation for high-risk major salivary gland cancers appears to offer a survival benefit. Although an overall survival benefit was not seen in low- and intermediate-risk salivary gland cancers, this study could not address impact on local control because of the limitations of the NCDB.
尚无随机数据支持在涎腺恶性肿瘤中使用术后放疗。本研究利用国家癌症数据库（NCDB）来描述涎腺癌患者的流行病学情况，并调查辅助放疗是否能提高总生存率。
从NCDB中识别出8243例被诊断为主要涎腺癌的患者。所有患者均接受了恶性肿瘤的初次手术切除。根据不良特征对患者进行风险分层，并确定总生存率。如果患者在切除后有包膜外扩展和/或切缘阳性，则被视为高危患者。如果患者不符合高危标准，但患有pT3 - T4期疾病、pN +期疾病、淋巴管间隙浸润、腺样囊性组织学类型或2 - 3级疾病，则被视为中危患者。不符合高危或中危标准的患者被视为低危患者。用描述性统计总结患者的总体人口统计学、疾病特征、治疗因素和结局，并使用STATA进行分析。
该队列的中位随访时间为42.4个月，中位年龄为58岁。高危组患者如果接受辅助放疗，生存率更高（风险比[HR]，0.76；P = 0.002；95%置信区间[CI]，0.64 - 0.91）。相比之下，中危组（HR，1.01；P = 0.904；95% CI，0.85 - 1.20）和低危组（HR，0.85；P = 0.427；95% CI，0.57 - 1.26）患者接受辅助放疗并未获得生存益处。
这项大型分析使用国家数据库比较了主要涎腺切除术后风险分层患者观察与单纯辅助放疗的生存结局。对于高危主要涎腺癌，使用辅助放疗似乎能带来生存益处。尽管在低危和中危涎腺癌中未观察到总体生存益处，但由于NCDB的局限性，本研究无法探讨对局部控制的影响。
