Friedman Aaron D, Gengler Isabelle, Altaye Mekibib, Tabangin Meredith E
Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
Laryngoscope. 2023 Apr;133(4):901-907. doi: 10.1002/lary.30305. Epub 2022 Jul 19.
Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large-scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC.
The NCDB was queried for all cases of T N M glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first-line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume.
34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non-academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non-metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model.
Most patients in the NCDB receive first-line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics.
4 Laryngoscope, 133:901-907, 2023.
利用大规模数据对早期声门癌（EGC）治疗选择的潜在影响因素进行的研究有限。美国国立癌症数据库（NCDB）涵盖了美国超过72%的新发癌症病例。我们推测，NCDB中的变量可能有助于深入了解EGC手术和放疗之间的治疗决策。
查询NCDB中2004年至2016年所有T N M声门癌病例。我们使用多变量逻辑回归分析来研究与一线治疗方式相关的因素：放射治疗（RT）与手术。所有报告的比值比（OR）均根据年龄、性别、种族、保险、大都市地区居住情况、地区和机构规模进行了调整。
34991例EGC患者接受了治疗：6687例（19%）接受手术；20289例（58%）接受RT；8015例（23%）接受手术加RT。接受RT（相对于单纯手术）的OR在以下情况时大于2：T分期更晚的癌症（OR 2.5 [95%CI：2.3，2.7]）、在非学术机构接受治疗（OR 2.8，[95%CI：2.6，3.0]）以及到治疗中心的距离较短（OR 2.2，[95%CI：2.0，2.4]）。在美国西部接受治疗、收入较高、有私人保险、居住在大都市（相对于非大都市）地区、女性、年龄较大以及机构规模较小的情况下，手术的可能性更大。在多变量模型中，西班牙裔种族、教育水平和种族与治疗类型无关。
NCDB中的大多数EGC患者接受一线放射治疗，这一决策与多种肿瘤、患者和治疗机构特征相关。
4 《喉镜》，133：901 - 907，2023年。
