Giacalone Nicholas J, Qureshi Muhammad M, Mak Kimberley S, Kirke Diana, Patel Sagar A, Shah Bhartesh A, Salama Andrew R, Jalisi Scharukh, Truong Minh Tam
Harvard Radiation Oncology Program, Boston, Massachusetts, U.S.A.
Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.
Laryngoscope. 2018 Apr;128(4):831-840. doi: 10.1002/lary.26798. Epub 2017 Aug 21.
OBJECTIVES/HYPOTHESIS: Randomized trials have demonstrated that adjuvant chemoradiotherapy (CRT) confers an overall survival (OS) benefit over adjuvant radiation therapy (RT) alone in patients with resected head and neck squamous cell carcinoma (HNSCC) with adverse pathologic features (positive surgical margins [SM+] and/or extracapsular extension [ECE]). Whether this OS benefit exists in an elderly population remains unknown.
Retrospective database study.
Using the National Cancer Database, we identified 1,686 elderly patients (age ≥70 years) with resected HNSCC with SM+ and/or ECE, who received adjuvant CRT (491 patients, 29%) or adjuvant RT alone (1,195 patients, 71%) between 1998 and 2011. Three-year survival rates were estimated using the Kaplan-Meier method both before and after propensity score matching (PSM). Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling.
Median follow-up was 23.5 and 42.8 months for all and surviving patients, respectively. Three-year OS was 50.7% and 44.4% among patients receiving adjuvant CRT and RT alone, respectively (P = .002). On multivariate analysis, there was no significant improvement in OS with adjuvant CRT relative to adjuvant RT alone (HR: 0.88, 95% CI: 0.73-1.06). Similarly, a PSM cohort showed no significant difference in the 3-year OS for patients receiving adjuvant CRT versus adjuvant RT alone (48.8% and 50.9%, respectively; P = .839).
Although the addition of chemotherapy to adjuvant RT has been proven effective in randomized trials of patients with resected HNSCC with SM+ or ECE, it may be less efficacious in an elderly patient population treated outside of a controlled trial setting.
2c. Laryngoscope, 128:831-840, 2018.
目的/假设：随机试验表明，对于具有不良病理特征（手术切缘阳性[SM+]和/或包膜外扩展[ECE]）的头颈部鳞状细胞癌（HNSCC）患者，辅助放化疗（CRT）相较于单纯辅助放疗（RT）可带来总生存期（OS）获益。但这一OS获益在老年人群中是否存在仍不清楚。
回顾性数据库研究。
利用国家癌症数据库，我们识别出1686例年龄≥70岁、具有SM+和/或ECE的HNSCC患者，这些患者在1998年至2011年间接受了辅助CRT（491例患者，29%）或单纯辅助RT（1195例患者，71%）。在倾向评分匹配（PSM）前后，均使用Kaplan-Meier方法估计三年生存率。使用Cox回归模型计算粗风险比（HR）和调整后的HR以及95%置信区间（CI）。
所有患者和存活患者的中位随访时间分别为23.5个月和42.8个月。接受辅助CRT和单纯RT的患者三年OS率分别为50.7%和44.4%（P = 0.002）。多因素分析显示，与单纯辅助RT相比，辅助CRT在OS方面无显著改善（HR：0.88，95%CI：0.73 - 1.06）。同样，PSM队列中接受辅助CRT与单纯辅助RT的患者三年OS无显著差异（分别为48.8%和50.9%；P = 0.839）。
尽管在具有SM+或ECE的HNSCC患者的随机试验中，辅助RT联合化疗已被证明有效，但在非对照试验环境下治疗的老年患者群体中，其疗效可能较差。
2c。《喉镜》，2018年，第128卷，第831 - 840页。
