Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
School of Stomatology, College of Medicine, Zhejiang University, Hangzhou, China.
Laryngoscope. 2024 Mar;134(3):1288-1298. doi: 10.1002/lary.31019. Epub 2023 Sep 2.
This study aimed to gather evidence for the survival benefit of cancer-directed surgery (CDS) in metastatic head and neck cancer (M1 HNC) and identify which patients will benefit most from CDS.
Patients with M1 HNC were identified within the SEER database. According to whether received CDS, patients were divided into the CDS and non-CDS groups. The bias between the two groups was minimized using Propensity Score Matching (PSM), and the prognostic role of CDS was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The primary endpoint was overall survival (OS), and the secondary endpoint was cancer-specific survival (CSS).
A total of 3215 patients with M1 HNC were extracted, including 566 patients who received CDS that were 1:1 propensity score-matched with patients who did not receive CDS. In the matched dataset, the median OS and CSS in CDS groups were significantly higher than in non-CDS groups (OS: 19.0 vs. 9.0 months, p < 0.001; CSS: 21.0 vs. 9.0 months, p < 0.001). Meanwhile, multivariable Cox regression analysis also revealed that CDS was a favorable prognostic factor for both OS and CSS. Furthermore, subgroups of patients with M1 HNC (younger age, being married, grade I-II, oropharynx site, earlier T/N stage, radiotherapy) were inclined to benefit from CDS, while those patients who received chemotherapy failed to benefit from CDS.
This study indicated that CDS was associated with improved survival in M1 HNC, especially for those subpopulations that benefit more from CDS treatment.
3 Laryngoscope, 134:1288-1298, 2024.
本研究旨在为转移性头颈部癌（M1 HNC）中癌症定向手术（CDS）的生存获益提供证据，并确定哪些患者将从 CDS 中获益最大。
在 SEER 数据库中识别出 M1 HNC 患者。根据是否接受 CDS，患者分为 CDS 组和非 CDS 组。采用倾向评分匹配（PSM）最小化两组之间的偏差，并采用 Kaplan-Meier 分析、对数秩检验和 Cox 比例风险模型探讨 CDS 的预后作用。主要终点是总生存期（OS），次要终点是癌症特异性生存期（CSS）。
共提取 3215 例 M1 HNC 患者，其中 566 例接受 CDS，与未接受 CDS 的患者 1:1 进行倾向评分匹配。在匹配数据集，CDS 组的中位 OS 和 CSS 显著高于非 CDS 组（OS：19.0 与 9.0 个月，p<0.001；CSS：21.0 与 9.0 个月，p<0.001）。同时，多变量 Cox 回归分析也显示 CDS 是 OS 和 CSS 的有利预后因素。此外，M1 HNC 的患者亚组（年龄较小、已婚、I-II 级、口咽部位、较早的 T/N 分期、放疗）更倾向于从 CDS 中获益，而接受化疗的患者则未能从 CDS 中获益。
本研究表明，CDS 与 M1 HNC 的生存改善相关，尤其是对那些更受益于 CDS 治疗的亚组。
3 级 Laryngoscope, 134:1288-1298, 2024.
