Wang Chenyang, Kishan Amar U, Raldow Ann, Beron Philip, Wong Deborah J, St John Maie, Steinberg Michael L, Chin Robert
Chenyang Wang, Amar U. Kishan, Ann Raldow, Philip Beron, Deborah J. Wong, Maie St John, Michael L. Steinberg, and Robert Chin, University of California, Los Angeles; and Maie St John, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA.
JCO Precis Oncol. 2019 Dec;3:1-14. doi: 10.1200/PO.18.00099.
The role of chemoradiation (CRT) in treating patients with early-stage glottic squamous cell carcinoma (SCC), especially for T2N0M0 glottic SCC with impaired vocal cord mobility, remains unexplored. We sought to evaluate the impact of CRT on survival in early-stage glottic SCC by using the SEER database.
We included patients with localized (T1-4N0M0) glottic SCC (N = 4,743) diagnosed between 2004 and 2014 and treated with definitive radiotherapy (RT) alone, CRT, or laryngectomy alone in the SEER database. Disease-specific mortality (DSM) was evaluated via multivariable regression using a competing risk model that accounts for other-cause mortality as a competing risk event for DSM. One-to-one propensity score matching between CRT and RT cohorts was also performed to facilitate comparison of cumulative DSM and other-cause mortality incidences stratified by T stage.
After stratification by T stage, CRT was associated with increased DSM in T1-2N0M0 glottic SCC (adjusted hazard ratios [AHRs], 4.222 and 2.260 for T1 and T2 disease, respectively; < .001 for both). For T2N0M0 glottic SCC with and without impaired vocal cord mobility, CRT resulted in significantly increased DSM compared with RT alone in both cohorts (AHR, 2.084; = .046 and AHR, 2.412; < .001, respectively). After propensity score matching, cumulative incidence plots demonstrated a statistically significant increase in DSM associated with CRT compared with RT alone for both T1 and T2 glottic SCC ( < .001 and = .003, respectively).
CRT for T1-2N0M0 glottic SCC was associated with increased DSM compared with RT alone. This pattern persisted upon further stratification on the basis of vocal cord mobility status for T2N0M0 glottic SCC. This finding warrants careful consideration of chemotherapy in early-stage glottic SCC.
放化疗（CRT）在早期声门鳞状细胞癌（SCC）患者治疗中的作用，尤其是对声带活动受限的T2N0M0声门SCC的作用，仍未得到充分研究。我们试图通过使用监测、流行病学和最终结果（SEER）数据库来评估CRT对早期声门SCC患者生存的影响。
我们纳入了2004年至2014年间在SEER数据库中诊断为局限性（T1 - 4N0M0）声门SCC（N = 4743）且接受单纯根治性放疗（RT）、CRT或单纯喉切除术治疗的患者。通过多变量回归，使用竞争风险模型评估疾病特异性死亡率（DSM），该模型将其他原因导致的死亡作为DSM的竞争风险事件。还对CRT和RT队列进行了一对一倾向评分匹配，以便于比较按T分期分层的累积DSM和其他原因导致的死亡率发生率。
按T分期分层后，CRT与T1 - 2N0M0声门SCC患者的DSM增加相关（T1和T2疾病的调整风险比[AHRs]分别为4.222和2.260；两者均P <.001）。对于有声带活动受限和无声带活动受限的T2N0M0声门SCC，与单纯RT相比，CRT在两个队列中均导致DSM显著增加（AHR分别为2.084，P =.046和AHR为2.412，P <.001）。倾向评分匹配后，累积发病率曲线显示，与单纯RT相比，CRT与T1和T2声门SCC的DSM增加具有统计学显著相关性（分别为P <.001和P =.003）。
与单纯RT相比，T1 - 2N0M0声门SCC的CRT与DSM增加相关。对于T2N0M0声门SCC，根据声带活动状态进一步分层后，这种模式仍然存在。这一发现值得在早期声门SCC的治疗中仔细考虑化疗的使用。
