接受手术及术后调强放疗的涎腺癌患者的肿瘤学结局：一项回顾性队列研究
Oncological outcomes of patients with salivary gland cancer treated with surgery and postoperative intensity-modulated radiotherapy: a retrospective cohort study.
作者信息
Zang Shoumei, Chen Meiqin, Huang Huijie, Zhu Xinli, Li Xinke, Yan Danfang, Yan Senxiang
机构信息
Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Radiation Oncology, Affiliated Jinhua Hospital, College of Medicine, Zhejiang University, Jinhua, China.
出版信息
Quant Imaging Med Surg. 2022 May;12(5):2841-2854. doi: 10.21037/qims-21-836.
BACKGROUND
Salivary gland cancer (SGC) is relatively rare and constitutes a variety of histological subtypes. Previously published studies of SGC patients suggest that postoperative radiation using conventional radiotherapy (RT) or 3-dimensional (3D) conformal radiotherapy may have led to suboptimal oncological outcomes.
METHODS
We identified 60 patients with major SGC treated with surgery followed by postoperative intensity-modulated radiotherapy (IMRT). Data for overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), prognostic factors, and treatment-related toxicities were analyzed. Survival was analyzed using the Kaplan-Meier method and compared using the log-rank test.
RESULTS
With a median follow-up of 55.5 months, based on Kaplan-Meier analyses, the OS and PFS rates for SGC patients at 3, 5, and 10 years were 90.7%, 85.1%, and 85.1% and 80.1%, 72.7%, and 63.1%, respectively. The LRRFS and DMFS rates at 3, 5, and 10 years were 87.4%, 82.1%, and 82.1% and 85.3%, 78.4%, and 66.1%, respectively. In multivariable analysis (MVA), the node stage (N stage) was an independent predictor of PFS [P=0.047; hazard ratio (HR) =0.089]. A positive margin was a significant prognostic factor for PFS (P=0.036; HR =4.086), LRRFS (P=0.026; HR =5.064), and DMFS (P=0.011; HR =6.367). Major nerve involvement was significantly correlated with PFS (P=0.034; HR =2.394) and DMFS (P=0.008; HR =2.115). The interval from surgery to radiotherapy predicted PFS (P=0.036; HR =3.934) and DMFS (P=0.012; HR =6.231). Adenoid cystic carcinoma (ACC) was the most common histology (n=21; 35%). For ACC, the 5-year OS, PFS, LRRFS, and DMFS were 100%, 67.7%, 76.2%, and 90.2%, respectively. The most common acute toxicities were mucositis and dermatitis, and xerostomia was the most common late adverse event. Lung metastasis was the most common pattern of distant failure.
CONCLUSIONS
N stage, positive margin, major nerve involvement, and interval from surgery to radiotherapy were important factors associated with PFS, LRRFS, and DMFS. Postoperative IMRT leads to improved survival for SGC patients, with acceptable toxicities.
背景
涎腺癌（SGC）相对罕见，包含多种组织学亚型。先前发表的关于涎腺癌患者的研究表明，使用传统放疗（RT）或三维（3D）适形放疗进行术后放疗可能导致肿瘤学结局欠佳。
方法
我们纳入了60例接受手术治疗并随后接受术后调强放疗（IMRT）的主要涎腺癌患者。分析了总生存期（OS）、无进展生存期（PFS）、局部区域无复发生存期（LRRFS）、远处无转移生存期（DMFS）、预后因素及治疗相关毒性的数据。采用Kaplan-Meier法分析生存期，并使用对数秩检验进行比较。
结果
中位随访时间为55.5个月，基于Kaplan-Meier分析，涎腺癌患者3年、5年和10年的OS率分别为90.7%、85.1%和85.1%，PFS率分别为80.1%、72.7%和63.1%。3年、5年和10年的LRRFS率分别为87.4%、82.1%和82.1%，DMFS率分别为85.3%、78.4%和66.1%。在多变量分析（MVA）中，淋巴结分期（N分期）是PFS的独立预测因素[P = 0.047；风险比（HR）= 0.089]。切缘阳性是PFS（P = 0.036；HR = 4.086）、LRRFS（P = 0.026；HR = 5.064）和DMFS（P = 0.011；HR = 6.367）的显著预后因素。主要神经受累与PFS（P = 0.034；HR = 2.394）和DMFS（P = 0.008；HR = 2.115）显著相关。从手术到放疗的间隔时间可预测PFS（P = 0.036；HR = 3.934）和DMFS（P = 0.012；HR = 6.231）。腺样囊性癌（ACC）是最常见的组织学类型（n = 21；35%）。对于ACC，5年OS、PFS、LRRFS和DMFS分别为100%、67.7%、76.2%和90.2%。最常见的急性毒性反应是黏膜炎和皮炎，口干是最常见的晚期不良事件。肺转移是最常见的远处失败模式。
结论
N分期、切缘阳性、主要神经受累以及从手术到放疗的间隔时间是与PFS、LRRFS和DMFS相关的重要因素。术后IMRT可提高涎腺癌患者的生存率，且毒性可接受。
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