鼻-鼻窦恶性肿瘤手术和辅助放疗的时机：手术入路的影响。
Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach.
机构信息
Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts.
Department of Otolaryngology - Head and Neck Surgery, Case Western Reserve University, Cleveland, Ohio.
出版信息
Head Neck. 2019 Oct;41(10):3551-3563. doi: 10.1002/hed.25873. Epub 2019 Jul 11.
BACKGROUND
Timely postoperative radiation therapy (RT) within 50 days of surgery for head and neck cancers provides a survival advantage.
METHODS
Using the National Cancer Database, we performed a propensity score-matched analysis comparing patients undergoing open or endoscopic surgery for squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses from 2010 to 2015.
RESULTS
Among 168 pairs, patients undergoing endoscopic surgery had shorter time to surgery (24.2 vs 36.7 days, P < .001) and shorter postoperative time to RT (PTTR, 51.2 vs 58.4 days, P = .02). On multivariable linear regression, endoscopic surgery predicted shorter PTTR (β = -7.6, P = .01). Using the Kaplan-Meier method, patients in the longest PTTR quartile had decreased overall survival (OS; Q1 vs Q4, 3-year OS 76.5% vs 53.3%, P = .007), a durable finding when adjusted for covariates (Q1 vs Q4, HR 0.50, P = .008).
CONCLUSIONS
Patients undergoing endoscopic surgery for sinonasal SCC experience shorter PTTR. Shorter PTTR is associated with extended OS.
背景
头颈部癌症患者术后 50 天内及时进行放射治疗（RT）可带来生存优势。
方法
利用国家癌症数据库，我们开展了一项倾向评分匹配分析，比较了 2010 年至 2015 年间接受开放式或内镜手术治疗鼻腔和鼻窦鳞状细胞癌（SCC）的患者。
结果
在 168 对患者中，接受内镜手术的患者手术时间更短（24.2 天 vs 36.7 天，P<.001），术后 RT 时间（PTTR）更短（51.2 天 vs 58.4 天，P=0.02）。多变量线性回归显示，内镜手术可预测 PTTR 更短（β=-7.6，P=0.01）。Kaplan-Meier 法显示，PTTR 最长四分位患者的总生存率（OS）降低（Q1 与 Q4 相比，3 年 OS 为 76.5%与 53.3%，P=0.007），当调整协变量时，这一结果具有持久性（Q1 与 Q4 相比，HR 0.50，P=0.008）。
结论
接受内镜手术治疗鼻窦 SCC 的患者的 PTTR 更短。PTTR 越短，OS 越持久。
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