Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO, USA.
Clinical Outcomes Research Office, Washington University School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2017 Nov;24(12):3494-3501. doi: 10.1245/s10434-017-6041-x. Epub 2017 Aug 14.
With the rise of oropharyngeal squamous cell carcinoma associated with human papillomavirus (HPV), appropriate treatment strategies continue to be tailored toward minimizing treatment while preserving oncologic outcomes. This study aimed to compare the outcomes for those undergoing transoral resection with or without adjuvant therapy for HPV-related oropharyngeal carcinoma.
A case-match cohort analysis was performed at two institutions on patients with HPV-related oropharyngeal squamous cell carcinoma. All the subjects underwent transoral surgery and neck dissection. The patients treated with surgery alone were matched 1:1 to those treated with surgery and adjuvant therapy using two groups identified as confounders: T-stage (T1/2 or T3/4) and number of pathologically positive lymph nodes (≤4 or >4).
The study identified 105 matched pairs, with a median follow-up period of 42 months (range 3.1-102.3 months). The patients were staged as T1/T2 (86%) or T3/4 (14%). Each group had five patients with more than four positive lymph nodes. Adjuvant therapy significantly improved disease-free survival (hazard ratio [HR] 0.067; 95% confidence interval [CI] 0.01-0.62) and was associated with a lower risk of local and regional recurrence (risk ratio [RR] 0.096; 95% CI 0.02-0.47). No difference in disease-specific survival (HR 0.22; 95% CI 0.02-2.57) or overall survival (HR 0.18; 95% CI 0.01-2.4) was observed with the addition of adjuvant therapy. The risk of the gastrostomy tube was higher for those receiving adjuvant therapy (RR 7.3; 95% CI 2.6-20.6).
Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.
随着与人类乳头瘤病毒（HPV）相关的口咽鳞状细胞癌的出现，合适的治疗策略不断针对最小化治疗的同时保留肿瘤学结果进行调整。本研究旨在比较接受单纯经口切除术与接受辅助治疗的 HPV 相关口咽癌患者的结局。
在两家机构进行了一项病例匹配队列分析，纳入 HPV 相关口咽鳞状细胞癌患者。所有患者均接受经口手术和颈部清扫术。单纯手术治疗的患者与接受手术和辅助治疗的患者进行 1:1 匹配，使用两组被确定为混杂因素的因素进行匹配：T 期（T1/2 或 T3/4）和病理阳性淋巴结数量（≤4 或 >4）。
本研究共纳入 105 对匹配患者，中位随访时间为 42 个月（范围 3.1-102.3 个月）。患者分期为 T1/T2（86%）或 T3/4（14%）。每组各有 5 例患者的阳性淋巴结数超过 4 个。辅助治疗显著改善了无病生存率（风险比[HR]0.067；95%置信区间[CI]0.01-0.62），并降低了局部和区域复发的风险（风险比[RR]0.096；95%CI0.02-0.47）。辅助治疗并未改善疾病特异性生存率（HR0.22；95%CI0.02-2.57）或总生存率（HR0.18；95%CI0.01-2.4）。接受辅助治疗的患者发生胃造口管的风险更高（RR7.3；95%CI2.6-20.6）。
经口手术是治疗 HPV 相关口咽癌的有效方法。辅助治疗似乎降低了复发风险，改善了无病生存率，但可能不会显著提高总生存率。
