Silverman Dustin A, Zhan Kevin Y, Puram Sidharth V, Eskander Antoine, Teknos Theodoros N, Rocco James W, Old Matthew O, Kang Stephen Y
Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA.
Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Siteman Cancer Center, Saint Louis, Missouri, USA.
Otolaryngol Head Neck Surg. 2020 Dec;163(6):1218-1225. doi: 10.1177/0194599820933183. Epub 2020 Jul 7.
Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC).
Retrospective observational study of the National Cancer Database.
National Cancer Database review from 2004 to 2014.
A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT.
The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively.
Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC.
早期声门癌治疗的指南推荐仅限于单独使用手术或放疗的单一模式治疗。我们试图研究与T1-T2N0声门鳞状细胞癌（SCC）患者激光切除术后辅助放疗（PORT）使用相关的临床病理和治疗因素。
对国家癌症数据库的回顾性观察研究。
2004年至2014年的国家癌症数据库回顾。
共纳入1338例接受原发性激光切除的原发性cT1-T2N0M0声门SCC患者。根据每年进行的喉部激光病例数量将医院分为四分位数。进行多因素逻辑回归以确定PORT的独立预测因素。
PORT的总体发生率为30.0%。PORT的预测因素包括在病例量较少的医院接受治疗（四分位数2-4的调整优势比[aOR]，1.32-4.84）、切缘阳性（aOR，3.83[95%CI，2.54-5.78]）和T2肿瘤（aOR，3.58[95%CI，2.24-5.74]）。PORT的使用与医院病例量呈强烈负相关。在病例量最高的四分位数医院中，PORT发生率为11.2%，而在第二、第三和第四四分位数机构中，PORT发生率分别为19.2%、32.2%和37.4%。
多变量分析中PORT的预测因素包括在病例量较少的机构接受治疗、切缘阳性和T2期疾病。本研究强调了在病例量较大的机构治疗早期声门癌的重要性。此外，有必要重新评估PORT的使用并降低早期声门SCC患者的双模式治疗率。
