Ding Shuo, Guo Wei, Yin Gaofei, Li Nuan, Liu Hongfei, Huang Junwei, Yang Zheng, Xu Hongbo, Chen Xiaohong, Zhang Yang, Huang Zhigang
Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2022 Jun;10(12):703. doi: 10.21037/atm-22-2630.
Although poorly differentiated is rare in head and neck squamous cell carcinoma (HNSCC), its prognosis are worse with high rate of local recurrence and distant metastasis (DS). Therefore, this study hopes to carry out prospective clinical research on different treatment options for poorly differentiated patients and explore the treatment scheme more suitable for these patients.
This study is a prospective cohort study. We selected patients with poorly differentiated carcinoma in larynx or hypopharynx (stage I-IV, T1-4a, N0-2, M0). The intervention treatment methods for stage I-II patients are as follows: surgery, induction chemotherapy (IC) + surgery, surgery + adjuvant therapy; The intervention treatment methods for stage III-IV patients are as follows: surgery, IC + surgery + adjuvant therapy, surgery + adjuvant therapy. The patients were followed up for at least 1 year, and the disease progression and survival were counted.
From September 2016 to October 2020, 62 patients were included (29 patients in stage I/II and 33 patients in stage III/IV). We found that there was no significant difference in survival between treatment groups in stage I/II patients [overall survival (OS): P=0.447; progression free survival (PFS): P=0.504], but the surgery + adjuvant treatment group had a significant advantage in 3-year OS (100%). In stage III/IV patients, there were significant differences in DS, OS and PFS between different treatment groups (DS: P=0.013; OS: P=0.021; PFS: P=0.020). Among them, the survival rate of IC + surgery + adjuvant treatment group was the best, with 3-year OS of 78%.
Our study found that postoperative radiotherapy may improve the OS rate of patients with early (stage I/II) poorly differentiated HNSCC; For advanced patients (stage III/IV), surgery combined with IC and postoperative adjuvant radiotherapy may better control DS and improve the survival rate. However, our study draws the above conclusions based on small sample data, and we will continue to summarize and expand the sample size for verification.
尽管低分化在头颈部鳞状细胞癌（HNSCC）中很少见，但其预后较差，局部复发率和远处转移（DS）率较高。因此，本研究希望对低分化患者的不同治疗方案进行前瞻性临床研究，并探索更适合这些患者的治疗方案。
本研究为前瞻性队列研究。我们选择了喉或下咽低分化癌患者（I-IV期，T1-4a，N0-2，M0）。I-II期患者的干预治疗方法如下：手术、诱导化疗（IC）+手术、手术+辅助治疗；III-IV期患者的干预治疗方法如下：手术、IC+手术+辅助治疗、手术+辅助治疗。对患者进行至少1年的随访，统计疾病进展和生存率。
2016年9月至2020年10月，共纳入62例患者（I/II期29例，III/IV期33例）。我们发现，I/II期患者各治疗组之间的生存率无显著差异[总生存期（OS）：P=0.447；无进展生存期（PFS）：P=0.504]，但手术+辅助治疗组在3年OS方面具有显著优势（100%）。在III/IV期患者中，不同治疗组之间的DS、OS和PFS存在显著差异（DS：P=0.013；OS：P=0.021；PFS：P=0.020）。其中，IC+手术+辅助治疗组的生存率最佳，3年OS为78%。
我们的研究发现，术后放疗可能提高早期（I/II期）低分化HNSCC患者的OS率；对于晚期患者（III/IV期），手术联合IC和术后辅助放疗可能更好地控制DS并提高生存率。然而，我们的研究基于小样本数据得出上述结论，我们将继续总结并扩大样本量进行验证。
