口腔鳞状细胞癌 pN1 术后放疗与观察比较。

Postoperative radiation therapy vs observation for pN1 oral cavity squamous cell carcinoma.

机构信息

Department of Otolaryngology, Mass. Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.

Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.

出版信息

Head Neck. 2019 Dec;41(12):4136-4142. doi: 10.1002/hed.25958. Epub 2019 Oct 7.

DOI:10.1002/hed.25958

PMID:31589006

Abstract

BACKGROUND

American Society of Clinical Oncology guidelines recommend that the decision to give postoperative radiotherapy (PORT) for pN1 oral cavity squamous cell carcinoma (OCSCC) without other adverse features be based on the adequacy of the neck dissection (<18 or ≥18 nodes).

METHODS

We conducted a cohort study of the National Cancer Database examining how PORT affects survival. We stratified analyses by the adequacy of the neck dissection and lymph node (LN) size.

RESULTS

Our cohort comprised 1909 patients (898 received PORT). PORT conferred a survival benefit in the overall cohort (adjusted hazard ratio 0.82, 95% CI 0.72-0.94). There was similar benefit in patients receiving inadequate and adequate neck dissections. Patients with >10 mm LN metastasis derived greater benefit compared with patients with smaller metastases.

CONCLUSIONS

In pN1 OCSCC without other adverse features, the size of the LN metastases may predict benefit from PORT, whereas the adequacy of the neck dissection may not.

摘要

背景

美国临床肿瘤学会指南建议，对于无其他不良特征的 pN1 口腔鳞状细胞癌（OCSCC）患者，是否给予术后放疗（PORT）应基于颈部清扫术的充分性（<18 或 ≥18 个淋巴结）。

方法

我们对国家癌症数据库进行了队列研究，以探讨 PORT 对生存的影响。我们按颈部清扫术和淋巴结（LN）大小的充分性进行了分层分析。

结果

我们的队列包括 1909 名患者（898 名接受了 PORT）。PORT 在总体队列中带来了生存获益（调整后的危险比为 0.82，95%CI 为 0.72-0.94）。在接受不充分和充分颈部清扫术的患者中，PORT 均带来了相似的获益。与淋巴结转移较小的患者相比，LN 转移>10mm 的患者获益更大。