接受手术和放疗的头颈癌患者治疗延迟与肿瘤学结局之间的关联
Association between treatment delays and oncologic outcome in patients treated with surgery and radiotherapy for head and neck cancer.
作者信息
Tumati Vasu, Hoang Lawrence, Sumer Baran D, Truelson John M, Myers Larry L, Khan Saad, Hughes Randall S, Nedzi Lucien, Sher David J
机构信息
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
Head Neck. 2019 Feb;41(2):315-321. doi: 10.1002/hed.25457. Epub 2018 Dec 13.
BACKGROUND
This study sought to determine the oncologic impact of delays to surgery, radiotherapy, and completion of therapy in patients with head and neck squamous cell carcinoma.
METHODS
The impact of biopsy to surgery (BTS) time, surgery to start of radiation time (STSR), and radiation treatment time (RTT) on locoregional recurrence (LRR), distant metastases (DMs), and cancer-specific mortality (CSM) was examined. The cumulative incidences (CI) of LRR, DMs, and CSM were examined using Fine-Gray testing.
RESULTS
A total of 277 patients treated with surgery and adjuvant radiotherapy were analyzed. On multivariable testing, BTS >50 days was associated with DM (P = .03), whereas RTT and STSR were not. RTT >43 days was associated with LRR (P = .02) in patients with non-p16-positive-oropharynx cancer.
CONCLUSIONS
An increase in DM appears to be the mechanism by which prolonged time to treatment initiation leads to worse overall survival. Prolonged RTT has the greatest impact on patients with non-p16 positive oropharynx cancers.
背景
本研究旨在确定手术延迟、放疗延迟以及治疗完成延迟对头颈部鳞状细胞癌患者肿瘤学方面的影响。
方法
研究了活检至手术时间（BTS）、手术至放疗开始时间（STSR）以及放射治疗时间（RTT）对局部区域复发（LRR）、远处转移（DM）和癌症特异性死亡率（CSM）的影响。使用Fine-Gray检验分析LRR、DM和CSM的累积发生率（CI）。
结果
共分析了277例接受手术和辅助放疗的患者。多变量分析显示，BTS>50天与DM相关（P = 0.03），而RTT和STSR与DM无关。在非p16阳性口咽癌患者中，RTT>43天与LRR相关（P = 0.02）。
结论
远处转移增加似乎是治疗开始时间延长导致总生存期较差的机制。放疗时间延长对非p16阳性口咽癌患者影响最大。
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