人乳头瘤病毒相关口咽鳞状细胞癌术后拒绝放疗。
Postoperative Radiation Therapy Refusal in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma.
机构信息
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A.
出版信息
Laryngoscope. 2022 Feb;132(2):339-348. doi: 10.1002/lary.29743. Epub 2021 Jul 13.
OBJECTIVES/HYPOTHESIS: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct clinical entity with good prognosis, unique demographics, and a trend toward treatment deintensification. Patients with this disease may opt out of recommended postoperative radiation therapy (PORT) for a variety of reasons. The aim of this paper was to examine factors that predict patient refusal of recommended PORT in HPV-associated OPSCC, and the association of refusal with overall survival.
STUDY DESIGN
Retrospective population-based cohort study of patients in the National Cancer Database.
METHODS
We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with OPSCC between January 2010 and December 2015. We primarily assessed overall survival and the odds of refusing PORT based on demographic, socioeconomic, and clinical factors. Analysis was conducted using multivariable logistic regression and multivariable Cox proportional hazards model.
RESULTS
A total of 4229 patients were included in the final analysis, with 156 (3.7%) patients opting out of recommended PORT. On multivariable analysis, patient refusal of PORT was independently associated with a variety of socioeconomic factors such as race, insurance status, comorbidity, treatment at a single facility, and margin status. Lastly, PORT refusal was associated with significantly lower overall survival compared to receipt of recommended PORT (hazard ratio 1.69, confidence interval 1.02-2.82).
CONCLUSIONS
Patient refusal of recommended PORT in HPV-associated OPSCC is rare and associated with variety of disease and socioeconomic factors. PORT refusal may decrease overall survival in this population. Our findings may help clinicians when counseling patients and identifying those who may be more likely to opt out of recommended adjuvant therapy.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:339-348, 2022.
目的/假设：人乳头瘤病毒（HPV）相关的口咽鳞状细胞癌（OPSCC）是一种具有良好预后的独特临床实体，具有独特的人口统计学特征，且治疗强度呈降低趋势。由于各种原因，患有这种疾病的患者可能会选择不接受推荐的术后放疗（PORT）。本文旨在研究预测 HPV 相关 OPSCC 患者拒绝推荐 PORT 的因素，以及拒绝 PORT 与总生存的关系。
研究设计
国家癌症数据库中患者的回顾性基于人群的队列研究。
方法
我们对国家癌症数据库中 2010 年 1 月至 2015 年 12 月期间诊断为 OPSCC 的患者进行了回顾性队列研究。我们主要根据人口统计学、社会经济和临床因素评估总生存和拒绝 PORT 的可能性。分析采用多变量逻辑回归和多变量 Cox 比例风险模型进行。
结果
共纳入 4229 例患者，最终分析中 156 例（3.7%）患者选择不接受推荐的 PORT。多变量分析显示，患者拒绝 PORT 与多种社会经济因素独立相关，如种族、保险状况、合并症、在单一机构治疗和切缘状态。最后，与接受推荐 PORT 相比，PORT 拒绝与显著较低的总生存率相关（风险比 1.69，置信区间 1.02-2.82）。
结论
HPV 相关 OPSCC 患者拒绝推荐的 PORT 很少见，与多种疾病和社会经济因素相关。在该人群中，PORT 拒绝可能会降低总生存率。我们的研究结果可能有助于临床医生在为患者提供咨询和识别那些更有可能选择不接受推荐辅助治疗的患者时提供帮助。
证据水平
3 级喉镜，132:339-348，2022 年。
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