1 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
2 Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Otolaryngol Head Neck Surg. 2019 Aug;161(2):288-296. doi: 10.1177/0194599819846073. Epub 2019 May 7.
The aim of the current study was to determine the incidence of organ function preservation failure (OFPF) in patients with head and neck squamous cell carcinoma (HNSCC) treated by (chemo)radiotherapy and to identify its risk factors.
Retrospective cohort analysis.
Tertiary cancer care center.
A single-center retrospective cohort analysis was done (n = 703) in which OFPF after (chemo)radiotherapy was assessed. OFPF was defined as local failure or pure functional failure in the absence of local failure because of major surgical intervention (total laryngectomy, commando resection, permanent tracheostomy) or feeding tube dependence >2 years.
OFPF occurred in 153 patients (21.8%). Reasons for OFPF were local failure in 103 patients (14.6%) and functional failure in 50 patients (7.2%). Evidence of functional failure included need for total laryngectomy (n = 9, 1.3%), commando resection (n = 2, 0.3%), permanent tracheostomy (n = 16, 2.3%), and/or long-term feeding tube for functional reasons (n = 23, 3.3%). In a Cox proportional hazards model, OFPF was worse for patients with T4 tumors (hazard ratio [HR] <0.5 and < .001 for all other stages), for laryngeal vs oropharyngeal cancer (HR, 1.83; 95% confidence interval [CI], 1.20-2.79, = .005, hypopharyngeal not significant), and for smokers (HR, 1.68; 95% CI, 1.10-2.56, = .015). Exploratory multivariate analysis by tumor site showed that T4 tumor and pretreatment tracheostomy were the strongest predictive factors for OFPF in laryngeal and hypopharyngeal carcinoma while T4 tumor and smoking were predictive for poor OFPF in oropharyngeal carcinoma.
This work shows a detrimental effect of smoking on functional outcomes after (chemo-)radiotherapy for HNSCC. Moreover, T4 tumor, laryngeal subsite, and pretreatment tracheostomy are strong predictors of OFPF.
本研究旨在确定接受放化疗治疗的头颈部鳞状细胞癌（HNSCC）患者的器官功能保存失败（OFPF）发生率，并确定其危险因素。
回顾性队列分析。
三级癌症治疗中心。
对单中心回顾性队列研究（n = 703）中，评估放化疗后 OFPF。OFPF 定义为局部失败或因主要手术干预（全喉切除术、突击队切除术、永久性气管造口术）或管饲依赖 >2 年而无局部失败导致的纯功能失败。
153 例患者（21.8%）发生 OFPF。OFPF 的原因包括 103 例（14.6%）患者局部失败和 50 例（7.2%）患者功能失败。功能失败的证据包括需要全喉切除术（n = 9，1.3%）、突击队切除术（n = 2，0.3%）、永久性气管造口术（n = 16，2.3%）和/或出于功能原因长期饲管（n = 23，3.3%）。在 Cox 比例风险模型中，T4 肿瘤患者的 OFPF 更差（所有其他阶段的风险比[HR] <0.5 和 <.001），与喉癌相比，口咽癌（HR，1.83；95%置信区间[CI]，1.20-2.79，.005，下咽癌无统计学意义），以及吸烟者（HR，1.68；95%CI，1.10-2.56，.015）。按肿瘤部位进行的探索性多变量分析显示，T4 肿瘤和预处理气管造口术是喉癌和下咽癌 OFPF 的最强预测因素，而 T4 肿瘤和吸烟是口咽癌不良 OFPF 的预测因素。
这项工作表明吸烟对头颈部鳞状细胞癌（HNSCC）放化疗后功能结局有不利影响。此外，T4 肿瘤、喉亚部位和预处理气管造口术是 OFPF 的强烈预测因素。
