中危特征口咽癌辅助放化疗的治疗模式和生存影响。
Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate-risk features.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.
出版信息
Head Neck. 2019 Sep;41(9):3177-3186. doi: 10.1002/hed.25808. Epub 2019 May 20.
BACKGROUND
Survival outcomes for adjuvant chemoradiotherapy (aCRT) and adjuvant radiotherapy (aRT) were compared in patients with oropharyngeal squamous cell carcinoma (OPSCC) with intermediate-risk features.
METHODS
We identified 2164 patients with OPSCC in the National Cancer Database without positive margins or extracapsular extension and with at least one intermediate-risk feature: pT3-T4 disease, ≥two positive lymph nodes, level IV/V nodal disease, and/or lymphovascular invasion. We assessed predictors of aCRT use and covariables impacting overall survival.
RESULTS
aCRT was commonly used for both human papillomavirus (HPV)-positive (62.0%) and HPV-negative (64.3%) patients with OPSCC. Higher N stage, level IV/V neck disease, and younger age strongly predicted aCRT utilization. There was no significant survival benefit associated with aCRT vs aRT in HPV-positive (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.62-1.38; P = .71) or HPV-negative (HR, 0.75; 95% CI, 0.51-1.10; P = .15) disease.
CONCLUSIONS
Despite high rates of utilization, aCRT is not associated with better survival vs aRT for OPSCC with intermediate-risk features, including HPV-negative tumors.
背景
比较了伴有中度风险特征的口咽鳞状细胞癌（OPSCC）患者接受辅助放化疗（aCRT）和辅助放疗（aRT）的生存结局。
方法
我们在国家癌症数据库中确定了 2164 例 OPSCC 患者，这些患者无阳性切缘或囊外扩展，且至少有一个中度风险特征：T3-T4 疾病、≥2 个阳性淋巴结、IV/ V 级颈部疾病和/或血管淋巴管侵犯。我们评估了 aCRT 使用的预测因素和影响总生存的协变量。
结果
伴有 OPSCC 的 HPV 阳性（62.0%）和 HPV 阴性（64.3%）患者中，aCRT 均被广泛应用。较高的 N 分期、IV/ V 级颈部疾病和较年轻的年龄强烈预测了 aCRT 的使用。与 aRT 相比，aCRT 在 HPV 阳性（危险比 [HR]，0.93；95%置信区间 [CI]，0.62-1.38；P = .71）或 HPV 阴性（HR，0.75；95% CI，0.51-1.10；P = .15）疾病中均无显著生存获益。
结论
尽管 aCRT 的使用率较高，但对于伴有中度风险特征的 OPSCC，包括 HPV 阴性肿瘤，aCRT 与 aRT 相比并不能带来更好的生存获益。
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