Mazul Angela L, Stepan Katelyn O, Barrett Thomas F, Thorstad Wade L, Massa Sean, Adkins Douglas R, Daly Mackenzie D, Rich Jason T, Paniello Randal C, Pipkorn Patrik, Zevallos Jose P, Jackson Ryan S, Kang Stephen Y, Puram Sidharth V
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States; Division of Public Health Sciences, Department of Surgery, Washington University, St Louis, MO, United States.
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States.
Oral Oncol. 2020 Sep;108:104819. doi: 10.1016/j.oraloncology.2020.104819. Epub 2020 May 30.
Delays in radiation are multifactorial, frequent, and associated with poor outcomes. This study investigates the effect of both primary and adjuvant radiation therapy duration and their interaction with other measures of treatment delay on survival in head and neck squamous cell carcinoma (HNSCC).
We built a retrospective cohort using the National Cancer Database, consisting of primary oral cavity, hypopharynx, larynx and oropharynx squamous cell carcinoma without distant metastasis and with at least six weeks of radiation. The primary exposure was the duration of radiation therapy (DRT), and the primary outcome was death. We estimated the association between DRT and 5-year overall survival (OS) using Kaplan-Meier curves and hazard ratios (HRs) with Cox proportional hazard regression.
In both primary (definitive) and adjuvant (post-surgical) radiation settings, increased DRT results in decreased survival. In the primary radiation cohort, 5-year OS was 59.7% [59.1%-60.3%] among those with 47-53 days DRT, which decreased significantly with each subsequent week to completion (81+ days: 38.4% [36.2%-40.7%]). In the surgical cohort, survival decreased 16.5% when DRT extended beyond 75 days (40-46 days: 68.2% [67.3%-69.1%] vs. 75+ days: 53.3% [50.1%-56.7%]). Multivariate analyses showed increased hazard of death with increased DRT (primary radiation: 81+ days HR: 1.69 [1.58-1.81]); surgical: 75+ days HR: 1.61 [1.37-1.88]), with effects intensifying when restricting to those receiving full-dose radiation.
A prolonged DRT was associated with worse OS in head and neck cancer. Radiation treatment delays of even a week lead to a significant survival disadvantage. DRT had a stronger association with survival than time to initiation of postoperative adjuvant radiotherapy.
放射治疗延迟是多因素导致的，很常见，且与不良预后相关。本研究调查了头颈部鳞状细胞癌（HNSCC）中根治性放疗和辅助性放疗持续时间的影响，以及它们与其他治疗延迟指标对生存的相互作用。
我们利用国家癌症数据库建立了一个回顾性队列，纳入原发性口腔、下咽、喉和口咽鳞状细胞癌患者，这些患者无远处转移且接受了至少六周的放疗。主要暴露因素是放疗持续时间（DRT），主要结局是死亡。我们使用Kaplan-Meier曲线和Cox比例风险回归的风险比（HRs）来估计DRT与5年总生存率（OS）之间的关联。
在根治性（确定性）放疗和辅助性（术后）放疗中，DRT增加均导致生存率降低。在根治性放疗队列中，DRT为47 - 53天的患者5年OS为59.7% [59.1% - 60.3%]，随着后续每延长一周直至完成放疗（超过81天：38.4% [36.2% - 40.7%]），生存率显著下降。在手术队列中，当DRT超过75天（40 - 46天：68.2% [67.3% - 69.1%] 与超过75天：53.3% [50.1% - 56.7%]）时，生存率下降16.5%。多因素分析显示，随着DRT增加，死亡风险增加（根治性放疗：超过81天HR：1.69 [1.58 - 1.81]）；手术放疗：超过75天HR：1.61 [1.37 - 1.88]），当仅限于接受全剂量放疗的患者时，这种影响会加剧。
头颈部癌中DRT延长与较差的OS相关。即使放疗延迟一周也会导致显著的生存劣势。DRT与生存的关联比术后辅助放疗开始时间与生存的关联更强。
