辅助放化疗在 T4N0 期 IV 期头颈部癌症中的作用：国家癌症数据库分析。

Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis.

机构信息

Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts.

Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts.

出版信息

Head Neck. 2018 Jun;40(6):1174-1184. doi: 10.1002/hed.25087. Epub 2018 Feb 8.

DOI:10.1002/hed.25087

PMID:29417687

Abstract

BACKGROUND

The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC).

METHODS

Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.

RESULTS

Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124).

CONCLUSION

In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.

摘要

背景

本研究旨在评估术后辅助放疗（手术+辅助 RT）与辅助放化疗（手术+辅助 CRT）在 T4N0M0、IV 期头颈部鳞状细胞癌（HNSCC）患者中的作用。

方法

1998 年至 2011 年间，分别有 3518 例和 885 例患者接受手术+辅助 RT 和手术+辅助 CRT 治疗。确定了 3 年总生存率（OS），计算了粗死亡率和调整后的危险比（HR）及其 95%置信区间（CI）。

结果

中位随访时间为 41.8 个月，报告死亡 2193 例。手术+辅助 RT 的 3 年 OS 为 67.5%，手术+辅助 CRT 为 70.5%（P=0.013）。对于阴性切缘，相应的 3 年 OS 为 70.1%和 74.9%（P=0.005）。对于阳性切缘，相应的 3 年 OS 为 56.0%和 60.6%（P=0.079）。多变量分析显示，辅助 CRT 相对于辅助 RT 的有益效果不显著（HR 0.90；CI 0.79-1.03；P=0.124）。