晚期喉癌患者喉功能丧失和生存失败。

Failed larynx preservation and survival in patients with advanced larynx cancer.

机构信息

Division of Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA.

Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.

出版信息

Am J Otolaryngol. 2019 Jul-Aug;40(4):542-546. doi: 10.1016/j.amjoto.2019.04.014. Epub 2019 Apr 22.

DOI:10.1016/j.amjoto.2019.04.014

PMID:31036417

Abstract

PURPOSE

To evaluate the survival benefit of total laryngectomy (TL) after induction chemotherapy in locally advanced laryngeal cancer patients.

MATERIALS AND METHODS

This is a retrospective study utilizing the National Cancer Database, which captures >80% of newly diagnosed head and neck squamous cell carcinoma cases in the United States. We included patients diagnosed with advanced stage laryngeal squamous cell carcinoma between 2004 and 2013 (n = 5649) who received either TL (n = 4113; 72.8%) or induction chemotherapy followed by either radiation therapy (n = 1431) or TL (n = 105). Kaplan-Meier curves and Cox proportional hazards regression were used to evaluate overall survival. A Cox regression model was computed to examine how the prognostic impact of treatment differed by clinical stage.

RESULTS

In multivariable analysis, when compared to patients receiving TL alone, those receiving induction chemotherapy followed by TL experienced no significant difference in survival (HR 0.85, 95% CI 0.63-1.13), while those receiving induction chemotherapy followed by radiation experienced poorer survival (HR 1.15, 95% CI 1.06-1.26). Induction chemotherapy followed by TL was associated with improved survival compared to induction chemotherapy and radiation (P = .042). Among patients with T4a tumors, TL (P < .001) and induction chemotherapy followed by TL (P = .002) were both associated with improved survival compared to induction chemotherapy and radiation. There were no survival differences between TL and induction chemotherapy followed by TL (HR 0.76, 95% CI 0.52-1.10).

CONCLUSIONS

Larynx preservation may be attempted without compromising survival in patients with locally advanced larynx cancer who fail induction chemotherapy and undergo TL.

摘要

目的

评估诱导化疗后行全喉切除术（TL）对局部晚期喉癌患者的生存获益。

材料与方法

这是一项利用国家癌症数据库进行的回顾性研究，该数据库涵盖了美国超过 80%的新发头颈部鳞状细胞癌病例。我们纳入了 2004 年至 2013 年间诊断为晚期喉鳞状细胞癌的患者（n=5649），这些患者接受了 TL（n=4113；72.8%）或诱导化疗，随后接受放疗（n=1431）或 TL（n=105）。使用 Kaplan-Meier 曲线和 Cox 比例风险回归评估总生存期。计算 Cox 回归模型以检查治疗的预后影响如何因临床分期而异。

结果

在多变量分析中，与单独接受 TL 的患者相比，接受诱导化疗后 TL 治疗的患者的生存无显著差异（HR 0.85，95%CI 0.63-1.13），而接受诱导化疗后放疗的患者的生存较差（HR 1.15，95%CI 1.06-1.26）。与诱导化疗和放疗相比，诱导化疗后 TL 与生存改善相关（P=0.042）。在 T4a 肿瘤患者中，TL（P<0.001）和诱导化疗后 TL（P=0.002）与诱导化疗和放疗相比均与生存改善相关。TL 和诱导化疗后 TL 之间的生存无差异（HR 0.76，95%CI 0.52-1.10）。