Luo Meng-Si, Huang Guan-Jiang, Liu Hong-Bing
Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong.
Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang.
Medicine (Baltimore). 2020 Nov 6;99(45):e23004. doi: 10.1097/MD.0000000000023004.
The option of T1a glottic cancer treatments remarkably varied in different countries. This study aimed to construct predictive models to predict overall survival (OS) and cancer-specific survival (CSS) of patients with initially diagnosed T1a glottic cancer. And we used propensity score matching (PSM) to reassess the effect of treatments.Data of patients with initially diagnosed T1a glottic cancer were extracted from the Surveillance, Epidemiology, and End Results database. Patients with complete information were randomly divided into the training and the validation cohorts (7:3). Cox regression was conducted to screen significant predictors of the OS and the CSS. PSM was performed to mimic randomized controlled trials. Survival analyses were performed by Kaplan-Meier survival methods, and log-rank tests were utilized.A total of 2342 patients met the inclusion criteria. Survival analyses showed that patients who underwent primary site surgery would have better OS and CSS. Univariate analyses and multivariate analyses proved that stage, N stage, primary site surgery, and chemotherapy significantly affected both the OS and the CSS. Predictive nomograms were established to predict patients' prognosis. Finally, the OS and the CSS for patients who underwent primary site surgery alone were significantly longer than those who underwent radiation alone before and after PSM.We constructed nomograms predicting the OS and the CSS of patients with initially diagnosed T1a glottic cancer. Compared to our previous studies, this study indicated that primary site surgery may be superior to radiation and chemotherapy. At present, chemotherapy should be not recommended for T1a glottic cancer patients.
不同国家T1a期声门癌的治疗选择差异显著。本研究旨在构建预测模型，以预测初诊为T1a期声门癌患者的总生存期（OS）和癌症特异性生存期（CSS）。我们使用倾向评分匹配（PSM）重新评估治疗效果。从监测、流行病学和最终结果数据库中提取初诊为T1a期声门癌患者的数据。将信息完整的患者随机分为训练队列和验证队列（7:3）。进行Cox回归以筛选OS和CSS的显著预测因素。采用PSM模拟随机对照试验。采用Kaplan-Meier生存方法进行生存分析，并使用对数秩检验。
共有2342例患者符合纳入标准。生存分析表明，接受原发部位手术的患者OS和CSS更佳。单因素分析和多因素分析均证明，分期、N分期、原发部位手术和化疗对OS和CSS均有显著影响。建立预测列线图以预测患者的预后。最后，在PSM前后，单纯接受原发部位手术患者的OS和CSS均显著长于单纯接受放疗的患者。
我们构建了预测初诊为T1a期声门癌患者OS和CSS的列线图。与我们之前的研究相比，本研究表明原发部位手术可能优于放疗和化疗。目前，不建议T1a期声门癌患者进行化疗。
