Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2024 May;170(5):1349-1363. doi: 10.1002/ohn.686. Epub 2024 Mar 1.
To compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC).
Retrospective cohort study.
The 2004 to 2019 National Cancer Database.
The NCDB was queried for patients with cT4b MSGC (N = 976). Patients undergoing definitive treatment with (1) surgical resection + adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan-Meier and Cox survival analyses.
Of 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection + adjuvant therapy and 71 (32.4%) underwent RT or CRT. There were no documented mortalities within 90 days of surgical resection. Tumor diameter and nodal metastasis were associated with decreased odds of undergoing definitive treatment (P < 0.025). Patients with positive surgical margins (PSM) had higher 5-year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs 30.1%, P = 0.018) and similar 5-year OS as those with negative margins (48.5% vs 54.0%, P = 0.205). Surgical resection + adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval [CI]: 0.37-0.84) was associated with higher OS than definitive RT or CRT (P < 0.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection + adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80-1.29, P = 0.896) tumors had similar OS.
A minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection + adjuvant therapy was safe and associated with higher OS than definitive RT or CRT, despite high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b MSGC may benefit from surgical resection.
比较 cT4b 大型涎腺癌（MSGC）的手术和非手术确定性治疗。
回顾性队列研究。
2004 年至 2019 年国家癌症数据库。
NCDB 对 cT4b MSGC 患者（N=976）进行了查询。接受（1）手术切除+辅助治疗、（2）单独放疗（RT）或（3）放化疗（CRT）确定性治疗的患者纳入 Kaplan-Meier 和 Cox 生存分析。
在接受确定性治疗的 219 例患者中，148 例（67.6%）接受了手术切除+辅助治疗，71 例（32.4%）接受了 RT 或 CRT。手术切除后 90 天内无死亡记录。肿瘤直径和淋巴结转移与接受确定性治疗的可能性降低相关（P<0.025）。切缘阳性（PSM）患者的 5 年总生存率（OS）高于接受确定性 RT 或 CRT 的患者（48.5%比 30.1%，P=0.018），与切缘阴性的患者相似（48.5%比 54.0%，P=0.205）。手术切除+辅助治疗（调整后的危险比：0.55，95%置信区间[CI]：0.37-0.84）与接受确定性 RT 或 CRT 相比，与更高的 OS 相关（P<0.025）。创建了一个单独的接受手术切除+辅助治疗的 961 例 cT4a 肿瘤患者队列；cT4a 和 cT4b（危险比：1.02，95%CI：0.80-1.29，P=0.896）肿瘤的 OS 相似。
少数 cT4b MSGC 患者接受确定性治疗。手术切除+辅助治疗是安全的，与确定性 RT 或 CRT 相比，OS 更高，尽管切缘阳性率很高。在没有临床试验数据的情况下，适当选择的 cT4b MSGC 患者可能受益于手术切除。
