Jayakrishnan Thejus T, White Richard J, Greenberg Larisa, Colonias Athanasios, Wegner Rodney E
Department of Internal Medicine Allegheny Health Network Pittsburgh PA.
Division of Medical Oncology Allegheny Health Network Cancer Institute Pittsburgh PA.
Laryngoscope Investig Otolaryngol. 2019 Dec 24;5(3):445-452. doi: 10.1002/lio2.327. eCollection 2020 Jun.
Squamous cell carcinoma (SCC) of larynx is a common head and neck cancer. For cases that are node negative, the role of definitive concurrent chemoradiation is unclear and not supported by guidelines but used at provider discretion. To address this knowledge gap, we examined the oncological outcomes with additional chemotherapy and factors correlated with the chemotherapy administration.
We queried the National Cancer Database for patients with early stage (T2N0M0) laryngeal SCC treated nonsurgically. Multivariable logistic regression identified predictors of chemotherapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases.
We identified 7181 patients meeting the eligibility criteria, of which 1568 (22%) patients received chemotherapy in addition to radiation. Predictors of chemotherapy use included younger age, Caucasian race, more remote year of treatment, higher grade, sites other than glottis, treatment at a community cancer center, and use of intensity-modulated radiation therapy. Median overall survival was not significantly different in the two arms analyzed-65 months (95% confidence interval [CI] 60, 72months) with chemotherapy compared to 70 months without chemotherapy (95% CI 66, 75 months, <.37). Predictors for survival on propensity-matched multivariable analysis were increased age, male sex, less education, lower income, higher comorbidity score, receipt of treatment at a community center, and nonglottic sites.
This study shows no clear survival benefit with chemotherapy in early stage disease. Although this implies that chemotherapy should not be routinely delivered, individualized judgment and prospective studies are recommended as the biology behind this interesting finding is undefined.
2C (Outcomes Research).
喉鳞状细胞癌（SCC）是一种常见的头颈部癌症。对于淋巴结阴性的病例，确定性同步放化疗的作用尚不清楚，且未得到指南支持，但由医疗服务提供者自行决定使用。为填补这一知识空白，我们研究了额外化疗的肿瘤学结局以及与化疗给药相关的因素。
我们查询了国家癌症数据库中接受非手术治疗的早期（T2N0M0）喉SCC患者。多变量逻辑回归确定了化疗的预测因素。多变量Cox回归评估了生存的预测因素。倾向匹配法考虑了指征偏倚。
我们确定了7181名符合纳入标准的患者，其中（22%）1568名患者除放疗外还接受了化疗。化疗使用的预测因素包括年龄较小、白种人、治疗年份较远、分级较高、声门以外的部位、在社区癌症中心接受治疗以及使用调强放射治疗。在分析的两组中，中位总生存期无显著差异——接受化疗的患者为65个月（95%置信区间[CI]60，72个月），未接受化疗的患者为70个月（95%CI66，75个月，P = 0.37）。倾向匹配多变量分析中生存的预测因素包括年龄增加、男性、教育程度较低、收入较低、合并症评分较高、在社区中心接受治疗以及非声门部位。
本研究表明早期疾病化疗无明显生存获益。虽然这意味着不应常规进行化疗，但由于这一有趣发现背后的生物学机制尚不清楚，建议进行个体化判断和前瞻性研究。
2C（结局研究）。
