Cancer Center, The First Hospital of Jilin University, Changchun, China.
Department of Otolaryngology-head and Neck Surgery, The First Hospital of Jilin University, Changchun, China.
Radiother Oncol. 2021 May;158:13-20. doi: 10.1016/j.radonc.2021.02.001. Epub 2021 Feb 13.
To assess the survival benefits associated with epidermal growth factor receptor (EGFR) inhibitors in head and neck squamous cell carcinoma (HNSCC) according to the primary site.
A systematic review and meta-analysis were conducted for randomized phase III trials comparing treatment with or without EGFR inhibitors in locoregionally advanced, recurrent, or metastatic HNSCC. The primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS), respectively. Data were pooled using a random-effects model.
Seven trials with a total of 3391 patients were included. The addition of EGFR inhibitors improved OS in patients with oral cavity-oropharyngeal carcinoma (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.67-0.87, P < 0.001) but not in patients with hypopharyngeal-laryngeal carcinoma (HR 0.94, 95% CI 0.82-1.08, P = 0.398). A significant interaction was found in favor of oral cavity-oropharyngeal carcinoma (P = 0.029). The addition of EGFR inhibitors increased PFS in both patients with oral cavity-oropharyngeal carcinoma (HR 0.67, 95% CI 0.52-0.85, P = 0.001) and patients with hypopharyngeal-laryngeal carcinoma (HR 0.81, 95% CI 0.69-0.94, P = 0.005). A trend towards significant interaction was found in favor of oral cavity-oropharyngeal carcinoma (P = 0.161). Comparable results were observed in the pre-specified subgroup analyses. Meta-regression analyses suggested that the primary site appeared to be a predictor of survival benefits in HNSCC patients who received treatment with EGFR inhibitors over those who did not.
Our meta-analysis suggests that the survival benefits of EGFR inhibitors might depend on primary sites in HNSCC. Further studies are needed to confirm this finding.
评估表皮生长因子受体（EGFR）抑制剂在头颈部鳞状细胞癌（HNSCC）中根据原发部位的生存获益。
对比较局部晚期、复发或转移性 HNSCC 患者接受或不接受 EGFR 抑制剂治疗的随机 III 期试验进行了系统评价和荟萃分析。主要和次要终点分别为总生存期（OS）和无进展生存期（PFS）。使用随机效应模型对数据进行汇总。
纳入了 7 项共 3391 例患者的试验。添加 EGFR 抑制剂可改善口腔-口咽癌患者的 OS（风险比[HR]0.77，95%置信区间[CI]0.67-0.87，P<0.001），但不能改善下咽-喉癌患者的 OS（HR 0.94，95%CI 0.82-1.08，P=0.398）。发现存在有利于口腔-口咽癌的显著交互作用（P=0.029）。添加 EGFR 抑制剂可增加口腔-口咽癌（HR 0.67，95%CI 0.52-0.85，P=0.001）和下咽-喉癌（HR 0.81，95%CI 0.69-0.94，P=0.005）患者的 PFS。发现存在有利于口腔-口咽癌的趋势性显著交互作用（P=0.161）。在预先指定的亚组分析中观察到了类似的结果。Meta 回归分析表明，原发部位似乎是接受 EGFR 抑制剂治疗的 HNSCC 患者生存获益的预测因素，而不是不接受治疗的患者。
我们的荟萃分析表明，EGFR 抑制剂的生存获益可能取决于 HNSCC 的原发部位。需要进一步的研究来证实这一发现。
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