Ladbury Colton, Liu Jason, Nelson Rebecca, Amini Arya, Maghami Ellie, Sampath Sagus
Radiation Oncology, City of Hope National Medical Center, Duarte, USA.
Biostatistics, City of Hope National Medical Center, Duarte, USA.
Cureus. 2022 Apr 11;14(4):e24038. doi: 10.7759/cureus.24038. eCollection 2022 Apr.
Introduction The treatment of primary salivary malignancies often requires a multimodality approach. The purpose of this analysis was to evaluate the interaction between primary tumor extent and the treatment location of postoperative radiotherapy (PORT) in patients with primary salivary malignancies with respect to survival outcomes. Methods Patients with primary salivary malignancies who underwent upfront surgery followed by radiation were queried in the National Cancer Database (NCDB). Patients were stratified by pathologic T stage and whether PORT was performed at the same or different facility as the definitive surgery. Survival outcomes were compared using the Kaplan-Meier method and Cox proportional hazards regression. Results A total of 5,553 patients were selected, of which 1,159 had pathologic T4 (pT4) tumors. Patients who received PORT at the same facility compared with a different facility demonstrated superior overall survival (OS) on log-rank analysis (p=0.003). On subgroup analysis, patients with pT4 tumors had superior OS (p=0.015), whereas patients with smaller T1-3 tumors did not. PORT receipt at the same surgical facility was not a significant predictor of OS on multivariable analysis when all patients were included (p=0.057). However, among patients with pT4 tumors, OS was improved in patients who got PORT at the same facility as their surgery (p=0.015), with 10-year survival rates of 38.3 (95% confidence interval (CI): 33%-44%) versus 31% (95%CI: 24%-38%). Conclusion OS was improved in patients with primary salivary malignancies who received PORT at the same facility as their surgery, but the difference appears to be primarily driven by patients with pT4 primary tumors.
引言 原发性涎腺恶性肿瘤的治疗通常需要多学科方法。本分析的目的是评估原发性涎腺恶性肿瘤患者的原发肿瘤范围与术后放疗（PORT）治疗部位之间在生存结果方面的相互作用。方法 在国家癌症数据库（NCDB）中查询接受了 upfront 手术并随后进行放疗的原发性涎腺恶性肿瘤患者。患者根据病理 T 分期以及 PORT 是否在与根治性手术相同或不同的机构进行分层。使用 Kaplan-Meier 方法和 Cox 比例风险回归比较生存结果。结果 共选择了 5553 例患者，其中 1159 例有病理 T4（pT4）肿瘤。在对数秩分析中，与在不同机构接受 PORT 的患者相比，在同一机构接受 PORT 的患者显示出更好的总生存期（OS）（p = 0.003）。在亚组分析中，pT4 肿瘤患者的 OS 更好（p = 0.015），而 T1-3 较小肿瘤的患者则不然。当纳入所有患者时，在多变量分析中，在同一手术机构接受 PORT 并不是 OS 的显著预测因素（p = 0.057）。然而，在 pT4 肿瘤患者中，在与手术相同机构接受 PORT 的患者 OS 有所改善（p = 0.015），10 年生存率分别为 38.3%（95%置信区间（CI）：33%-44%）和 31%（95%CI：24%-38%）。结论 原发性涎腺恶性肿瘤患者在与手术相同机构接受 PORT 时 OS 有所改善，但这种差异似乎主要由 pT4 原发性肿瘤患者驱动。
