1 Department of Surgery, Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA.
2 Center for Head & Neck Oncology, New York Head & Neck Institute, North Shore-LIJ Cancer Institute, New York, New York, USA.
Otolaryngol Head Neck Surg. 2019 Apr;160(4):658-663. doi: 10.1177/0194599818804777. Epub 2018 Oct 9.
In advanced maxillary sinus cancers treated with surgery and radiotherapy, poor local control rates and the potential for organ preservation have prompted interest in the use of systemic therapy. Our objective was to present outcomes for induction compared to adjuvant chemotherapy in the maxillary sinus.
Secondary database analysis.
National Cancer Database (NCDB).
In total, 218 cases of squamous cell maxillary sinus cancer treated with surgery, radiation, and chemotherapy between 2004 and 2012 were identified from the NCDB and stratified into induction chemotherapy and adjuvant chemotherapy cohorts. Univariate Kaplan-Meier analyses were compared by log-rank test, and multivariate Cox regression was performed to evaluate overall survival when adjusting for other prognostic factors. Propensity score matching was also used for further comparison.
Twenty-three patients received induction chemotherapy (10.6%) and 195 adjuvant chemotherapy (89.4%). The log-rank test comparing induction to adjuvant chemotherapy was not significant ( P = .076). In multivariate Cox regression when adjusting for age, sex, race, comorbidity, grade, insurance, and T/N stage, there was a significant mortality hazard ratio of 2.305 for adjuvant relative to induction chemotherapy (confidence interval, 1.076-4.937; P = .032).
Induction chemotherapy was associated with improved overall survival in comparison to adjuvant chemotherapy in a relatively small cohort of patients (in whom treatment choice cannot be characterized), suggesting that this question warrants further investigation in a controlled clinical trial before any recommendations are made.
在接受手术和放疗治疗的晚期上颌窦癌患者中，局部控制率差和有保留器官的潜力促使人们对全身治疗的使用产生了兴趣。我们的目的是在上颌窦癌中报告诱导化疗与辅助化疗的结果。
二级数据库分析。
国家癌症数据库（NCDB）。
共从 NCDB 中确定了 218 例 2004 年至 2012 年期间接受手术、放疗和化疗治疗的鳞状细胞上颌窦癌病例，并将其分为诱导化疗和辅助化疗队列。单变量 Kaplan-Meier 分析通过对数秩检验进行比较，多变量 Cox 回归用于调整其他预后因素后评估总生存期。还使用倾向评分匹配进行进一步比较。
23 例患者接受诱导化疗（10.6%），195 例患者接受辅助化疗（89.4%）。比较诱导化疗与辅助化疗的对数秩检验不显著（P=0.076）。在调整年龄、性别、种族、合并症、分级、保险和 T/N 分期等因素的多变量 Cox 回归中，与诱导化疗相比，辅助化疗的死亡风险比为 2.305（置信区间，1.076-4.937；P=0.032）。
与辅助化疗相比，在相对较小的患者队列（其中治疗选择无法确定）中，诱导化疗与总体生存改善相关，这表明在提出任何建议之前，这个问题需要在对照临床试验中进一步研究。
