Boston University School of Medicine, Radiation Oncology, 830 Harrison Ave, Moakley Building LL 237, Boston, MA 02118, USA.
Boston University School of Medicine, Otolaryngology, Head and Neck Surgery, 830 Harrison Ave 1st Floor, Suite 1400, Boston, MA 02118, USA.
Am J Otolaryngol. 2020 Sep-Oct;41(5):102544. doi: 10.1016/j.amjoto.2020.102544. Epub 2020 May 15.
Early-stage glottic laryngeal cancer is treated with surgery or radiotherapy (RT), but limited randomized data exists to support one modality over the other. This study evaluates survival differences in early glottic cancer patients treated with either surgery or RT.
14,498 patients with early glottic cancer diagnosed from 2004 to 2015 and treated with surgery or RT were identified in the National Cancer Database. Kaplan-Meier method was used to analyze differences in overall survival (OS) by treatment (surgery vs. RT) and radiation dose fractionation. Cox regression modeling and propensity score-matched (PSM) analysis were performed. Adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) were computed.
Median follow-up and median OS for all patients were 49.5 and 118 months, respectively. The estimated 5-year OS for surgery and RT was 77.5% and 72.6%, respectively (P < 0.0001). On multivariate analysis, aHR (95% CI) for surgery compared to RT was 0.87 (0.81-0.94, P = 0.0004). Compared to RT regimen 63-67.5 Gray (Gy) in 28-30 fractions, worse survival was noted for RT regimen 66-70 Gy in 33-35 fractions (aHR 1.15, 95% CI 1.07-1.23, P = 0.0003). When compared with hypofractionated RT (63-67.5 Gy in 28-30 fractions), patients undergoing surgery no longer showed improved OS (aHR 0.94, 95% CI 0.86-1.02, P = 0.154). The finding was confirmed on PSM analysis (surgery aHR 0.95, 95% CI 0.87-1.05, P = 0.322).
In early glottic tumors, patients treated with surgery demonstrated improved survival compared to RT, but when hypofractionation was considered, there were no significant differences in OS between patients undergoing surgery or RT.
早期声门型喉癌的治疗方法为手术或放疗（RT），但支持其中一种方法优于另一种方法的随机数据有限。本研究评估了接受手术或 RT 治疗的早期声门型癌症患者的生存差异。
在国家癌症数据库中，确定了 2004 年至 2015 年间诊断为早期声门型癌症并接受手术或 RT 治疗的 14498 名患者。采用 Kaplan-Meier 法分析治疗（手术与 RT）和放射剂量分割方式对总生存率（OS）的影响。采用 Cox 回归模型和倾向评分匹配（PSM）分析进行分析。计算了调整后的危险比（aHR）及其 95%置信区间（95%CI）。
所有患者的中位随访时间和中位 OS 分别为 49.5 个月和 118 个月。手术和 RT 的估计 5 年 OS 分别为 77.5%和 72.6%（P<0.0001）。多变量分析显示，手术与 RT 相比，aHR（95%CI）为 0.87（0.81-0.94，P=0.0004）。与 RT 方案 63-67.5 Gy 分 28-30 次相比，RT 方案 66-70 Gy 分 33-35 次的生存情况更差（aHR 1.15，95%CI 1.07-1.23，P=0.0003）。与低分割 RT（63-67.5 Gy 分 28-30 次）相比，接受手术的患者的 OS 不再提高（aHR 0.94，95%CI 0.86-1.02，P=0.154）。PSM 分析结果也证实了这一点（手术 aHR 0.95，95%CI 0.87-1.05，P=0.322）。
在早期声门型肿瘤中，与 RT 相比，手术治疗患者的生存率有所提高，但当考虑低分割时，手术与 RT 治疗患者的 OS 无显著差异。
