Department of Otolaryngology, University of California, Davis, Sacramento.
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2019 Feb 1;145(2):153-158. doi: 10.1001/jamaoto.2018.3650.
Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck.
To assess indications for adjuvant radiation therapy in patients with CSCC.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016.
Data were compared between treatment groups with a χ2 analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression.
A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease.
Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease.
皮肤鳞状细胞癌（CSCC）是全球最常见的恶性肿瘤之一。关于头颈部晚期 CSCC 肿瘤的辅助放疗的适应证和益处，存在相互矛盾的证据。
评估 CSCC 患者接受辅助放疗的适应证。
设计、地点和参与者：对 2008 年 1 月 1 日至 2016 年 6 月 30 日在 2 个三级转诊中心接受原发切除手术联合或不联合辅助放疗的 349 例头颈部 CSCC 患者进行回顾性分析。
采用 χ2 分析比较治疗组之间的数据。采用 Kaplan-Meier 生存分析和对数秩检验以及 Cox 比例风险多变量回归分析无病生存（DFS）和总生存（OS）。
共有 349 例患者符合纳入标准（平均[SD]年龄为 70[12]岁；年龄范围为 32-94 岁；302[86.5%]为男性），191 例（54.7%）接受了辅助放疗。5 年 Kaplan-Meier 估计值分别为 DFS 的 59.4%和 OS 的 47.4%。较大的、局部转移性的、分化差的、伴有神经周围侵犯（PNI）的肿瘤和年轻的免疫抑制患者更可能接受辅助放疗。在 Cox 比例风险多变量回归中，眶周肿瘤（HR，2.48；95%CI，1.00-6.16）、PNI（HR，1.90；95%CI，1.12-3.19）或 N2 或更高的淋巴结疾病（HR，2.16；95%CI，1.13-4.16）的患者 DFS 较低。免疫抑制患者（HR，2.17；95%CI，1.12-4.17）和 N2 或更高的淋巴结疾病（HR，2.43；95%CI，1.42-4.17）患者 OS 较低。辅助放疗与全队列 OS 改善相关（HR，0.59；95%CI，0.38-0.90）。在伴有 PNI 的肿瘤亚组分析中，辅助放疗与 DFS（HR，0.47；95%CI，0.23-0.93）和 OS（HR，0.44；95%CI，0.24-0.86）改善相关。辅助放疗还与区域疾病患者的 DFS（HR，0.36；95%CI，0.15-0.84）和 OS（HR，0.30；95%CI，0.15-0.61）改善相关。
在晚期 CSCC 患者中，接受辅助放疗与伴有 PNI 和区域疾病患者的生存改善相关。
