Department of Otolaryngology-Head & Neck Surgery, University of Missouri, Columbia, Missouri, USA.
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Otolaryngol Head Neck Surg. 2023 Jun;168(6):1420-1432. doi: 10.1002/ohn.205. Epub 2023 Jan 19.
Patient factors associated with failure to receive adjuvant therapy after oral cavity cancer resection remain understudied. Here, we identified rates of missed adjuvant therapy, determined factors associated with missed therapy, and assessed associations with survival.
Retrospective cohort.
National Cancer Database.
Patients with resected oral cavity squamous cell carcinoma and known adjuvant therapy status were included. T3-4 stage, N2-3 stage, and lymphovascular invasion were considered indications for adjuvant radiation. Extranodal extension or positive margins were considered indications for chemoradiation. Patient factors were examined for associations with missed adjuvant therapy. Overall survival was evaluated by Cox proportional hazard analysis.
A total of 53,503 patients were included. 27.5% missed adjuvant therapy altogether, and 26.7% with a documented indication for chemoradiation missed chemotherapy. Factors associated with missed adjuvant therapy were age, white race, low income, metropolitan population, increasing comorbidities, travel distance, lip primary, and treatment at the academic facility. Factors associated with missed chemotherapy were age, female sex, nontongue subsite, and treatment at a nonacademic center. Among patients with indications for adjuvant radiation, missed radiation was associated with worse overall survival (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.31-1.53). Among patients with indications for adjuvant chemoradiation, missed chemotherapy was associated with worse overall survival (HR: 1.19, 95% CI: 1.09-1.29).
Missed adjuvant therapy occurs frequently after oral cavity resection. Patients treated at academic centers may be at risk of missed therapy related to travel distance, though these patients are more likely to receive adjuvant chemotherapy when indicated. Missed adjuvant therapy is associated with worse survival.
口腔癌切除术后辅助治疗失败的患者相关因素仍研究不足。本研究旨在确定未接受辅助治疗的发生率，确定与治疗遗漏相关的因素，并评估其与生存的相关性。
回顾性队列研究。
国家癌症数据库。
纳入接受口腔鳞状细胞癌切除术且已知辅助治疗情况的患者。T3-4 期、N2-3 期和脉管侵犯被认为是辅助放疗的指征。淋巴结外侵犯或阳性切缘被认为是放化疗的指征。患者因素与辅助治疗遗漏相关。采用 Cox 比例风险分析评估总生存率。
共纳入 53503 例患者。27.5%的患者总体上未接受辅助治疗，26.7%有明确放化疗指征的患者未接受化疗。与辅助治疗遗漏相关的因素包括年龄、白种人、低收入、大都市人口、合并症增多、就诊距离、唇原发肿瘤和在学术机构治疗。与化疗遗漏相关的因素包括年龄、女性、非舌部位肿瘤和在非学术中心治疗。在有辅助放疗指征的患者中，漏放疗与总生存较差相关（风险比[HR]：1.42，95%置信区间[CI]：1.31-1.53）。在有辅助放化疗指征的患者中，漏化疗与总生存较差相关（HR：1.19，95%CI：1.09-1.29）。
口腔癌切除术后辅助治疗遗漏较为常见。在学术中心接受治疗的患者可能因就诊距离而面临治疗遗漏的风险，但这些患者在有指征时更可能接受辅助化疗。辅助治疗遗漏与生存较差相关。
