Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Otolaryngology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
Laryngoscope. 2024 May;134(5):2243-2251. doi: 10.1002/lary.31177. Epub 2023 Nov 10.
Determine if intensive local therapy (i.e., local surgery or radiation) has a survival benefit for patients presenting with distantly metastatic oropharyngeal squamous cell carcinoma (OPSCC).
Retrospective population-based cohort study of patients in the National Cancer Database presenting with distantly metastatic OPSCC. Overall survival (OS) was compared for patients receiving systemic therapy alone or in combination with local surgery or curative dose radiation, controlling for various clinicodemographic factors.
Between 2010 and 2015, 627 patients presented with newly diagnosed, metastatic OPSCC and an initial treatment course including systemic chemotherapy. Multivariable analysis demonstrated that local radiation therapy was independently associated with improved OS (OR 0.64, CI [0.51-0.81]); local surgery was not independently associated with improved OS (OR 0.99, CI [0.65-1.53]). Higher T stages were associated with worse OS (OR 1.69, CI [1.14-2.50] for T3 and OR 1.77, CI [1.22-2.58] for T4 compared to T1). HPV-positive (HPV+) tumors were associated with improved OS compared to HPV- (OR 0.79, CI [0.64-0.97]). Multiagent chemotherapy was associated with improved OS compared to single-agent (OR 0.78, CI [0.62-1.00]). The best survival for the entire cohort and for HPV+ patients was for radiation with systemic therapy and the worst survival for systemic therapy alone.
Curative dose local radiotherapy in addition to systemic therapy is associated with improved OS compared to systemic therapy alone in patients presenting with distantly metastatic OPSCC. There is not a significant survival benefit for local surgery in addition to systemic therapy in this patient population, regardless of HPV status.
3 Laryngoscope, 134:2243-2251, 2024.
确定对于远处转移性口咽鳞状细胞癌（OPSCC）患者，强化局部治疗（即局部手术或放疗）是否具有生存获益。
对国家癌症数据库中患有远处转移性 OPSCC 的患者进行回顾性基于人群的队列研究。对仅接受全身治疗或联合局部手术或根治剂量放疗的患者进行总体生存（OS）比较，并控制了各种临床病理因素。
在 2010 年至 2015 年间，627 例新诊断为转移性 OPSCC 的患者接受了包括全身化疗在内的初始治疗方案。多变量分析表明，局部放射治疗与改善 OS 独立相关（OR 0.64，CI [0.51-0.81]）；局部手术与改善 OS 无独立相关性（OR 0.99，CI [0.65-1.53]）。较高的 T 分期与较差的 OS 相关（与 T1 相比，T3 的 OR 为 1.69，CI [1.14-2.50]，T4 的 OR 为 1.77，CI [1.22-2.58]）。HPV 阳性（HPV+）肿瘤与 HPV-（OR 0.79，CI [0.64-0.97]）相比，OS 改善。与单药治疗相比，联合化疗与 OS 改善相关（OR 0.78，CI [0.62-1.00]）。整个队列和 HPV+患者的最佳生存是全身治疗联合放疗，而全身治疗的生存最差。
与单独接受全身治疗相比，在患有远处转移性 OPSCC 的患者中，联合局部根治剂量放疗可改善生存。在该患者人群中，无论 HPV 状态如何，联合局部手术治疗并不能显著提高生存率。
3 级喉镜，134：2243-2251，2024。
