IVA-IVB 期下咽鳞状细胞癌患者的复发风险分层与治疗策略。
Recurrence risk stratification and treatment strategies of patients with stage IVa-b hypopharyngeal squamous cell carcinoma.
机构信息
ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China.
出版信息
Head Neck. 2022 Sep;44(9):2030-2039. doi: 10.1002/hed.27074.
BACKGROUND
Optimal treatment strategies for patients with stage IVa-b hypopharyngeal squamous cell carcinoma (HSCC) remain controversial. This study aimed to examine the high-risk factors of postoperative tumor recurrence after surgical resection of HSCC and devise individualized postoperative adjuvant treatment (POAT).
METHODS
Overall, 218 patients with stage IVa-b HSCC who received surgery as initial treatment and with negative surgical margins were evaluated. Independent risk factors of recurrence were identified, and survival outcomes were compared according to recurrence risk and POAT use.
RESULTS
POAT significantly improved recurrence-free survival (RFS) and overall survival (OS) only in the high-risk patients (p = 0.003 and 0.018, respectively). Compared with postoperative radiotherapy alone, postoperative chemoradiotherapy (pCRT) achieved significantly better RFS (p = 0.035) and OS (p = 0.048).
CONCLUSIONS
POATs are recommended for high-risk patients with stage Iva-b HSCC, with pCRT achieving superior outcomes. Regular re-examination after tumor resection is sufficient for low-risk patients.
背景
对于 IVa-b 期下咽鳞状细胞癌（HSCC）患者的最佳治疗策略仍存在争议。本研究旨在探讨手术切除 HSCC 后肿瘤复发的高危因素，并制定个体化的术后辅助治疗（POAT）方案。
方法
共评估了 218 例接受手术作为初始治疗且切缘阴性的 IVa-b 期 HSCC 患者。确定了复发的独立危险因素，并根据复发风险和 POAT 使用情况比较了生存结果。
结果
POAT 仅在高危患者中显著改善了无复发生存（RFS）和总生存（OS）（p=0.003 和 0.018）。与单纯术后放疗相比，术后放化疗（pCRT）显著改善了 RFS（p=0.035）和 OS（p=0.048）。
结论
POAT 推荐用于 IVa-b 期 HSCC 的高危患者，pCRT 可获得更好的结果。对于低危患者，肿瘤切除后定期复查即可。
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