Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Head Neck. 2018 Jun;40(6):1228-1236. doi: 10.1002/hed.25100. Epub 2018 Feb 8.
Postoperative concomitant chemoradiotherapy (CRT) improves outcomes for younger adults with head and neck squamous cell carcinoma (HNSCC) and positive margins or extranodal extension (ENE), but its benefit for older adults is not well established.
Patients from the National Cancer Data Base (NCDB) with HNSCC undergoing curative-intent resection, neck dissection, and postoperative radiation with positive margins or ENE were identified.
This analysis included 1199 patients aged ≥ 70 years with median follow-up of 42.6 months. Postoperative concurrent CRT was associated with improved overall survival (OS; hazard ratio [HR] 0.752; 95% confidence interval [CI] 0.638-0.886) compared to radiation alone in multivariable analysis. Three-year OS was 52.4% with CRT versus 43.4% with radiation (P = .012) in propensity-score matched cohorts. The survival impact of CRT varied by N classification (P = .002 for interaction), with benefit seen only in those with N2 to N3 disease.
Postoperative concurrent CRT may benefit older patients with HNSCC with positive margins or ENE, particularly those with higher nodal burden.
术后同步放化疗（CRT）可改善伴有阳性切缘或结外侵犯（ENE）的年轻头颈鳞癌（HNSCC）患者的预后，但对于老年患者的疗效尚不清楚。
从国家癌症数据库（NCDB）中筛选出接受根治性切除术、颈部清扫术和术后放疗，且伴有阳性切缘或 ENE 的 HNSCC 患者。
本分析纳入了 1199 例年龄≥70 岁的患者，中位随访时间为 42.6 个月。多变量分析显示，与单纯放疗相比，术后同步 CRT 可改善总体生存（OS；风险比 [HR] 0.752；95%置信区间 [CI] 0.638-0.886）。在倾向评分匹配队列中，CRT 组的 3 年 OS 为 52.4%，而放疗组为 43.4%（P=0.012）。CRT 的生存获益因 N 分期而异（交互检验 P=0.002），仅在 N2 至 N3 疾病患者中观察到获益。
术后同步 CRT 可能有益于伴有阳性切缘或 ENE 的老年 HNSCC 患者，尤其是那些淋巴结受累程度较高的患者。
