Wichmann Gunnar, Pavlychenko Mykola, Willner Maria, Halama Dirk, Kuhnt Thomas, Kluge Regine, Gradistanac Tanja, Fest Sandra, Wald Theresa, Lethaus Bernd, Dietz Andreas, Wiegand Susanne, Zebralla Veit
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany.
Department of Maxillofacial Surgery, University Hospital Leipzig, Leipzig, Germany.
Front Oncol. 2021 Nov 10;11:737080. doi: 10.3389/fonc.2021.737080. eCollection 2021.
Standardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III-IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated.
As MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (=104) and cohort 2 since 2007 (=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients.
Most patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM.
Despite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.
在多学科肿瘤委员会（MDTB）中，对口腔鳞状细胞癌（OSCC）患者进行标准化的分期程序，并在治疗前展示以及应用选择性颈清扫术（ND），有望改善治疗效果，尤其是在局部晚期口咽鳞状细胞癌（LAOSCC，国际抗癌联盟（UICC）III-IVB期）患者中。由于目前尚未证明标准化诊断以及治疗方法中增加的异质性能改善LAOSCC患者的治疗效果，因此开展了一项回顾性研究。
由于MDTB于2007年引入临床常规，对我院1991 - 2017年期间治疗的316例LAOSCC患者进行分层，分为2007年之前治疗的队列1（=104例）和2007年之后的队列2（=212例）。使用卡方检验比较患者的临床特征、诊断程序和治疗方式，并应用Kaplan-Meier曲线和对数秩检验以及Cox比例风险回归分析治疗结果。使用倾向评分（PS）来阐明PS匹配患者远处无转移生存期（DMFS）受损的预测因素。
大多数患者特征和应用的治疗方式显示无显著变化。手术治疗中，原发肿瘤切除加颈清扫术、气管切开术和经皮内镜胃造瘘管使用的情况明显增多。以顺铂为基础的放化疗最为常见。2006年后，仅疾病无进展生存期（DFS）、进展无进展生存期（PFS）和无事件生存期（EFS）以及肿瘤特异性生存期（TSS）和总生存期（OS）有不显著的改善，而局部控制率（LC）和局部区域控制率（LRC）显著提高，但DMFS显著受损。对PS匹配患者应用Cox回归分析表明，N3、属于队列2以及以顺铂为基础的放化疗是DMFS缩短的独立预测因素。队列2中放化疗期间地塞米松使用增加与远处转移增加相关。
尽管有标准化的诊断程序，但考虑明确适应症的决策制定和改进的治疗方案导致LC和LRC有所改善，然而假设与地塞米松使用增加相关的DMFS缩短对TSS和OS产生了不利影响。
