Amdur R J, Parsons J T, Mendenhall W M, Million R R, Stringer S P, Cassisi N J
University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1989 Jan;16(1):25-36. doi: 10.1016/0360-3016(89)90006-0.
One hundred thirty-four patients with advanced head and neck cancer were treated with radical surgery and postoperative radiation therapy between October 1964 and October 1984. All patients had greater than or equal to 2 years and 84% had greater than or equal to 5 years of follow-up. All patients included in the study were scheduled to receive continuous-course irradiation following a major cancer operation for previously untreated squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx and began radiation treatment less than or equal to 3 months after the surgical procedure. Ninety-six percent had AJCC pathologic Stage III or IV cancer, and all were without evidence of gross disease at the start of irradiation. The majority of recurrences above the clavicles occurred in the primary field (84%) as opposed to the posterior strip (8%) or low neck (8%). Based on multivariate analysis and tabular comparisons, 4 factors were found to be significantly important for predicting disease control above the clavicles: (a) Surgical margin (5-year actuarial control with invasive cancer at the margin, 53%, versus 81% with negative margins, p = .009). Patients with close margins or in situ cancer at the margins had the same rate of control as those with negative margins. (b) Primary site (oral cavity, 64%, versus other sites, 83%; p = .029). (c) Neck Stage (N0-1 versus N2-3). (d) Number of indications for irradiation--for example, bone invasion, multiple positive nodes, perineural invasion (1-3 indications, 85%, versus greater than or equal to 4, 62%; p = .06). The rate of disease control above the clavicles did not correlate well with AJCC pathologic stage: Stage I-II, 67%; Stage III, 81%; Stage IVA (T1-3, N2-3A), 68%; Stage IVB (T4 and/or N3B), 80%. The interval between surgery and the start of irradiation (range 1-10 weeks) also was not prognostically important, even with stratification by tumor dose, surgical margin, and number of indications for irradiation. At 5 years, the actuarial survival rate was 33% for the entire group; for patients with invasive cancer at the margin, the survival rate was approximately half that of those whose margins were free of invasive cancer (17% versus 37%). Based on multivariate analysis, 2 factors were found to significantly increase the probability of death due to cancer: (a) neck Stage (N0-1 versus N2-3); (b) extension of tumor from the primary site into the skin or soft tissues of the neck.(ABSTRACT TRUNCATED AT 400 WORDS)
1964年10月至1984年10月期间，134例晚期头颈癌患者接受了根治性手术及术后放疗。所有患者的随访时间均≥2年，84%的患者随访时间≥5年。本研究纳入的所有患者均计划在接受口腔、口咽、下咽或喉鳞状细胞癌的初次癌症手术后接受连续疗程的放疗，且在手术操作后≤3个月开始放疗。96%的患者为美国癌症联合委员会（AJCC）病理分期III期或IV期癌症，且在放疗开始时均无肉眼可见的疾病证据。锁骨以上部位的复发大多发生在原发区域（84%），而非后缘区域（8%）或下颈部（8%）。基于多因素分析和表格比较，发现有4个因素对于预测锁骨以上部位的疾病控制具有显著重要性：（a）手术切缘（切缘有浸润性癌的患者5年精算控制率为53%，切缘阴性的患者为81%，p = 0.009）。切缘接近或切缘为原位癌的患者与切缘阴性的患者控制率相同。（b）原发部位（口腔，64%，其他部位，83%；p = 0.029）。（c）颈部分期（N0 - 1期与N2 - 3期）。（d）放疗指征数量——例如，骨侵犯、多个阳性淋巴结、神经周围侵犯（1 - 3个指征，85%，≥4个指征，62%；p = 0.06）。锁骨以上部位的疾病控制率与AJCC病理分期的相关性不佳：I - II期，67%；III期，81%；IVA期（T1 - 3，N2 - 3A），68%；IVB期（T4和/或N3B），80%。手术与放疗开始之间的间隔时间（范围为1 - 10周）在预后方面也不重要，即使按肿瘤剂量、手术切缘和放疗指征数量进行分层分析也是如此。5年时，整个研究组的精算生存率为33%；切缘有浸润性癌的患者生存率约为切缘无浸润性癌患者的一半（17%对37%）。基于多因素分析，发现有2个因素会显著增加因癌症死亡的概率：（a）颈部分期（N0 - 1期与N2 - 3期）；（b）肿瘤从原发部位延伸至颈部皮肤或软组织。（摘要截断于400字）
