Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore.
Cancer. 2021 Jun 15;127(12):1984-1992. doi: 10.1002/cncr.33471. Epub 2021 Feb 25.
Neoadjuvant chemotherapy (NAC) is used in head and neck squamous cell carcinoma (HNSCC) for downstaging advanced disease and decreasing distant metastasis (DM). To the authors' knowledge, no study has specifically examined the impact of a delayed time to surgery (TTS) after NAC on oncologic outcomes. They thus aimed to identify a cutoff for TTS after NAC and its effect on survival indices.
This was a retrospective review of all patients with HNSCC receiving NAC followed by surgery with curative intent between March 2016 and March 2019 at the MD Anderson Cancer Center. Receiver operating characteristic analysis was used to identify a cutoff for TTS, and this cutoff was used to analyze the overall survival (OS), locoregional recurrence rate, DM-free rate, and disease-free survival (DFS). A multivariate Cox regression analysis was performed.
One hundred one patients were analyzed with a median follow-up of 24.7 months. The 3-year OS and locoregional recurrence rates did not differ with a TTS ≥ 34 days. However, the 3-year DM-free rate was significantly worse (56% vs 90%; P = .001) in the group with a TTS ≥ 34 days, and the 3-year DFS was significantly lower (26% vs 64%; P = .006). In a multivariate analysis, a TTS ≥ 34 days (hazard ratio [HR], 4.92; 95% confidence interval [CI], 1.84-13.13) and extracapsular extension (HR, 3.01; 95% CI, 1.13-8.00) were significant independent predictors of a poorer DM-free rate. Weight loss > 10% (HR, 5.53; 95% CI, 1.02-30.24) was the only independent predictor for a TTS ≥ 34 days.
Emphasis should be placed on early definitive locoregional treatment after NAC, particularly in patients who do not respond to NAC. There is a need to validate these findings and establish new benchmarks for the interval between NAC and surgery.
新辅助化疗（NAC）用于头颈部鳞状细胞癌（HNSCC）以降期晚期疾病并减少远处转移（DM）。据作者所知，尚无研究专门研究 NAC 后手术时间（TTS）延迟对肿瘤学结果的影响。因此，他们旨在确定 NAC 后 TTS 的截止值及其对生存指标的影响。
这是一项回顾性研究，对 2016 年 3 月至 2019 年 3 月期间在 MD 安德森癌症中心接受 NAC 治疗后接受根治性手术的所有 HNSCC 患者进行了回顾性分析。使用受试者工作特征分析确定 TTS 的截止值，并使用该截止值分析总生存率（OS）、局部区域复发率、DM 无复发生率和无病生存率（DFS）。进行了多变量 Cox 回归分析。
分析了 101 例患者，中位随访时间为 24.7 个月。TTS≥34 天时，3 年 OS 和局部区域复发率没有差异。然而，TTS≥34 天时，3 年 DM 无复发生率显著更差（56%对 90%；P=.001），3 年 DFS 显著更低（26%对 64%；P=.006）。在多变量分析中，TTS≥34 天（危险比[HR]，4.92；95%置信区间[CI]，1.84-13.13）和囊外扩展（HR，3.01；95%CI，1.13-8.00）是 DM 无复发生率较差的独立显著预测因子。体重减轻>10%（HR，5.53；95%CI，1.02-30.24）是 TTS≥34 天的唯一独立预测因子。
应强调 NAC 后早期确定性局部区域治疗，特别是在对 NAC 无反应的患者中。需要验证这些发现并为 NAC 和手术之间的间隔建立新的基准。
