Department of Radiation Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang Provincial Clinical Research Center for Cancer, Hangzhou, China.
J Clin Oncol. 2024 May 20;42(15):1754-1765. doi: 10.1200/JCO.23.01106. Epub 2024 Apr 1.
To identify subgroups of patients with early-stage (pT1-2N0M0) oral tongue squamous cell carcinoma (OTSCC) who may benefit from postoperative radiotherapy (PORT).
This retrospective cohort study included 528 patients diagnosed between October 2009 and December 2021. Clinicopathological characteristics and treatments with or without PORT were analyzed for their impact on outcomes.
Among 528 patients who underwent radical surgery (median age, 62 years [IQR, 52-69]), 145 (27.5%) also underwent PORT. Multivariate analyses revealed that PORT was associated with improved survival outcomes, whereas moderate-to-poor differentiation, perineural infiltration (PNI), lymphovascular invasion (LVI), and increasing depth of invasion (DOI) were associated with poorer survival outcomes. For patients with moderate-to-poor differentiation, the surgery + PORT group showed improved outcomes compared with the surgery-alone group. After propensity score matching, the results were as follows: overall survival (OS), 97% versus 69%, = .003; disease-free survival (DFS), 88% versus 50%, = .001. After excluding cases with PNI/LVI, the differences persisted: OS, 97% versus 82%, = .040; DFS, 87% versus 64%, = .012. Similar survival benefits were observed in 104 patients with PNI and/or LVI (OS, 81% 58%; = .022; DFS, 76% 47%; = .002). In subgroups with DOI >5 mm or close margins, PORT contributed to improved DFS (80% 64%; = .006; 92% 66%; = .049) but did not significantly affect OS.
Patients with moderately-to-poorly differentiated pT1-2N0M0 OTSCC benefited from PORT. Our study provided evidence that patients with PNI and/or LVI who underwent PORT had improved survival. PORT also offered DFS benefit among patients with DOI >5 mm.
确定早期（pT1-2N0M0）口腔舌鳞状细胞癌（OTSCC）患者的亚组，这些患者可能从术后放疗（PORT）中获益。
本回顾性队列研究纳入了 2009 年 10 月至 2021 年 12 月期间诊断的 528 例患者。分析了有无 PORT 的临床病理特征和治疗对结局的影响。
在 528 例接受根治性手术（中位年龄 62 岁[IQR，52-69]）的患者中，145 例（27.5%）还接受了 PORT。多变量分析显示，PORT 与生存结局改善相关，而中-低分化、神经周围浸润（PNI）、淋巴血管浸润（LVI）和浸润深度增加（DOI）与生存结局较差相关。对于中-低分化的患者，手术+PORT 组的结局优于手术组。经过倾向评分匹配后，结果如下：总生存（OS），97%对 69%， =.003；无病生存（DFS），88%对 50%， =.001。排除 PNI/LVI 病例后，差异仍然存在：OS，97%对 82%， =.040；DFS，87%对 64%， =.012。在 104 例有 PNI 和/或 LVI 的患者中也观察到类似的生存获益（OS，81% 58%， =.022；DFS，76% 47%， =.002）。在 DOI＞5mm 或切缘接近的亚组中，PORT 有助于改善 DFS（80% 64%， =.006；92% 66%， =.049），但对 OS 无显著影响。
中-低分化 pT1-2N0M0 OTSCC 患者从 PORT 中获益。本研究提供了证据表明，接受 PORT 的有 PNI 和/或 LVI 的患者生存得到改善。在 DOI＞5mm 的患者中，PORT 也可带来 DFS 获益。
