Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Biometrics Department, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Oral Oncol. 2019 Aug;95:143-149. doi: 10.1016/j.oraloncology.2019.06.018. Epub 2019 Jun 22.
To assess the functional outcomes of patients treated for hypopharynx cancer and to obtain an unbiased estimate of survival difference between patients treated with chemoradiotherapy (CRT) or total laryngectomy (TL).
Retrospective cohort study of all patients treated with curative intent for T1-T4 squamous cell carcinoma of the hypopharynx in The Netherlands Cancer Institute (1990-2013). Functional outcome following radiotherapy (RT) or CRT was measured using laryngo-esophageal dysfunction free survival rate (LDFS). Using propensity score (PS) matched analysis, we compared survival outcome of TL to CRT in T2-T4 patients.
We included 343 patients with T1T4 hypopharynx cancer. LDFS 2 and 5-years following CRT was respectively 44 and 32%. Following RT this was 39 and 30%. Patients were matched on the following variables: age, gender, TNM classification, subsite of tumor, decade of diagnosis, prior cancer, smoking, ACE27 score, BMI hemoglobin, albumin, and leukocyte level. With PS matching, we were able to match 26 TL patients with 26 CRT patients. The OS rates for TL and CRT in this matched cohort were respectively 56% and 46% at 5 years and 35% and 17% at 10 years.
In conclusion, functional outcomes following RT or CRT are suboptimal and require improved treatment strategies or rehabilitation efforts. The OS results challenge the preposition that CRT and TLE are equivalent in terms of survival.
评估接受下咽癌治疗的患者的功能预后，并获得接受放化疗（CRT）或全喉切除术（TL）治疗的患者之间生存差异的无偏估计。
对荷兰癌症研究所（1990-2013 年）所有接受根治性治疗的 T1-T4 下咽鳞状细胞癌患者进行回顾性队列研究。使用喉食管功能障碍无生存（LDFS）率来衡量放疗（RT）或 CRT 后的功能预后。通过倾向评分（PS）匹配分析，我们比较了 T2-T4 患者 TL 与 CRT 的生存结果。
我们纳入了 343 例 T1T4 下咽癌患者。CRT 后 2 年和 5 年的 LDFS 分别为 44%和 32%。RT 后分别为 39%和 30%。患者在以下变量上进行了匹配：年龄、性别、TNM 分期、肿瘤部位、诊断十年、既往癌症、吸烟、ACE27 评分、BMI、血红蛋白、白蛋白和白细胞水平。通过 PS 匹配，我们能够将 26 例 TL 患者与 26 例 CRT 患者相匹配。在该匹配队列中，TL 和 CRT 的 OS 率分别为 5 年时的 56%和 46%，10 年时的 35%和 17%。
总之，RT 或 CRT 后的功能预后并不理想，需要改进治疗策略或康复努力。OS 结果挑战了 CRT 和 TLE 在生存方面等效的假设。
