手术治疗的口咽癌治疗延误对生存的影响及人乳头瘤病毒状态的作用。
Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status.
机构信息
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.
出版信息
Head Neck. 2019 Jun;41(6):1756-1769. doi: 10.1002/hed.25643. Epub 2019 Jan 7.
BACKGROUND
The impact of treatment delays on survival in oropharyngeal cancer and whether the effect varies by human papillomavirus (HPV) status have yet to be defined.
METHODS
Retrospective analysis of the survival impact of time from diagnosis to surgery (DTS), surgery to radiation (SRT), and duration of radiation (RTD) for patients in the National Cancer Database with resected oropharyngeal cancer who underwent adjuvant radiation from 2010 to 2014.
RESULTS
We identified optimal thresholds of 30, 40, and 51 days for DTS, SRT, and RTD, respectively, with treatment times exceeding these thresholds associated with significantly worse overall survival. Prolonged SRT and RTD were associated with mortality regardless of HPV status, although rising DTS was only predictive among patients with HPV-negative tumors.
CONCLUSIONS
Treatment delays significantly impact survival in oropharyngeal cancer. The consequences of prolonged DTS may be stronger in HPV-negative than HPV-positive disease. These data serve as a foundation for future research and clinical management.
背景
治疗延误对口咽癌患者生存的影响，以及这种影响是否因人类乳头状瘤病毒（HPV）状态而异，目前尚未确定。
方法
回顾性分析了 2010 年至 2014 年间在国家癌症数据库中接受辅助放疗的接受手术切除的口咽癌患者，从诊断到手术（DTS）、手术到放疗（SRT）和放疗时间（RTD）对生存的影响。
结果
我们确定了 DTS、SRT 和 RTD 的最佳阈值分别为 30、40 和 51 天，治疗时间超过这些阈值与总生存率显著降低相关。SRT 和 RTD 延长与死亡率相关，无论 HPV 状态如何，尽管 DTS 升高仅在 HPV 阴性肿瘤患者中具有预测性。
结论
治疗延误对口咽癌的生存有显著影响。DTS 延长的后果在 HPV 阴性疾病中可能比 HPV 阳性疾病更强。这些数据为未来的研究和临床管理提供了基础。
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