Ko Huaising C, Harari Paul M, Chen Shuai, Wieland Aaron M, Yu Menggang, Baschnagel Andrew M, Kimple Randall J, Witek Matthew E
Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison.
Department of Biostatistics and Medical Informatics, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 1;143(11):1126-1133. doi: 10.1001/jamaoto.2017.1756.
Radiotherapy (RT)-based organ preservation approaches for patients with advanced laryngeal cancer have been established stepwise through prospective randomized clinical trials. However, broad adoption of these approaches has stimulated discussion about long-term results challenging their applicability in a heterogeneous patient population, most recently for patients with T3 disease.
To define outcomes in patients with clinical T3N0M0 glottic laryngeal cancer treated with definitive surgical and RT-based approaches.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients treated from January 1, 2004, through December 31, 2013, with a median follow-up time of 58 months (range, 0-126.6 months) in the National Cancer Database. Of the 4003 patients with T3N0M0 disease, 2622 received definitive therapy defined by the study protocol. Data were obtained from the clinical oncology database sourced from hospital registry data that are collected from more than 1500 Commission on Cancer-accredited facilities. Data were analyzed from September 14, 2016, through April 24, 2017.
Radiotherapy, chemoradiotherapy, surgery, surgery and RT, or surgery and chemoradiotherapy.
Five-year overall survival (OS).
A total of 2622 patients (2251 men [85.9%] and 371 women [14.1%]; median age, 64 years [range, 19-90 years]) were included in the analytic cohort. In the overall patient cohort, the adjusted 5-year survival probability was 53%. No statistical differences were observed between the primary surgery (53%; 95% CI, 48%-57%) and primary RT (54%; 95% CI, 52%-57%) cohorts. In multivariate analysis, patient factors associated with decreased OS included age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.04), insurance status (HR, 1.26; 95% CI, 1.06-1.50), and increasing comorbidity (HR, 1.20; 95% CI, 1.02-1.42).
Current management of T3N0M0 glottic laryngeal cancer relies largely on RT-based organ preservation approaches. The present study substantiates randomized clinical trial data supporting the use of RT-based organ preservation approaches for patients with T3N0M0 glottic laryngeal cancer without compromising OS.
针对晚期喉癌患者，基于放疗（RT）的器官保留方法已通过前瞻性随机临床试验逐步确立。然而，这些方法的广泛应用引发了关于长期结果的讨论，质疑其在异质性患者群体中的适用性，最近针对T3期疾病患者。
确定采用确定性手术和基于RT的方法治疗的临床T3N0M0声门型喉癌患者的结局。
设计、设置和参与者：这项回顾性队列研究纳入了2004年1月1日至2013年12月31日期间接受治疗的患者，在国家癌症数据库中的中位随访时间为58个月（范围为0至126.6个月）。在4003例T3N0M0疾病患者中，2622例接受了研究方案定义的确定性治疗。数据来自临床肿瘤学数据库，该数据库源自医院登记数据，这些数据是从1500多个癌症委员会认可的机构收集的。数据分析时间为2016年9月14日至2017年4月24日。
放疗、放化疗、手术、手术加RT或手术加放化疗。
五年总生存率（OS）。
分析队列共纳入2622例患者（2251例男性[85.9%]和371例女性[14.1%]；中位年龄64岁[范围为19至90岁]）。在整个患者队列中，调整后的5年生存概率为53%。在原发手术组（53%；95%CI，48%-57%）和原发RT组（54%；95%CI，52%-57%）之间未观察到统计学差异。在多变量分析中，与OS降低相关的患者因素包括年龄（风险比[HR]，1.04；95%CI，1.03-1.04）、保险状况（HR，1.26；95%CI，1.06-1.50）和合并症增加（HR，1.20；95%CI，1.02-1.42）。
目前T3N0M0声门型喉癌的管理很大程度上依赖于基于RT的器官保留方法。本研究证实了随机临床试验数据，支持对T3N0M0声门型喉癌患者使用基于RT的器官保留方法，且不影响OS。
