对比 cT1-2N0M0 口腔鳞癌初始手术与剂量≥6600 cGy 的根治性放疗的临床结局：一项全国性队列研究。
Comparing the clinical outcomes of initial surgery and primary definitive radiotherapy with a dosage of 6600 cGy or higher in cT1-2N0M0 oral cavity squamous cell carcinoma: A nationwide cohort study.
机构信息
Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan, ROC.
出版信息
Cancer Med. 2024 May;13(10):e7127. doi: 10.1002/cam4.7127.
BACKGROUND
To compare the clinical outcomes of two treatment modalities, initial surgery and primary definitive radiotherapy (RT), in Taiwanese patients diagnosed with cT1-2N0M0 oral cavity squamous cell carcinoma (OCSCC).
METHODS
Between 2011 and 2019, we analyzed data for 13,542 cT1-2N0M0 patients who underwent initial surgery (n = 13,542) or definitive RT with a dosage of at least 6600 cGy (n = 145) for the treatment of OCSCC. To account for baseline differences, we employed propensity score (PS) matching, resulting in two well-balanced study groups (initial surgery, n = 580; definitive RT, n = 145).
RESULTS
Before PS matching, the 5-year disease-specific survival (DSS) rates were 88% for the surgery group and 58% for the RT group. After PS matching, the 5-year DSS rates of the two groups were 86% and 58%, respectively. Similarly, the 5-year overall survival (OS) rates before PS matching were 80% for the surgery group and 36% for the RT group, whereas after PS matching, they were 73% and 36%, respectively. All these differences were statistically significant (p < 0.0001). A multivariable analysis identified treatment with RT, older age, stage II tumors, and a higher burden of comorbidities as independent risk factors for both DSS and OS. We also examined the 5-year outcomes for various subgroups (margin ≥5 mm, margin <5 mm, positive margins, RT combined with chemotherapy, and RT alone) as follows: DSS, 89%/88%/79%/63%/51%, respectively, p < 0.0001; OS, 82%/79%/68%/39%/32%, respectively, p < 0.0001.
CONCLUSIONS
In Taiwanese patients with cT1-2N0M0 OCSCC, a remarkably low proportion (1.1%) completed definitive RT. A significant survival disparity of 30% was observed between patients who underwent initial surgery and those who received definitive RT. Interestingly, even patients from the surgical group with positive surgical margins exhibited a significantly superior survival compared to those in the definitive RT group.
背景
本研究旨在比较初始手术和根治性放疗（RT）两种治疗模式在台湾 cT1-2N0M0 口腔鳞状细胞癌（OCSCC）患者中的临床结局。
方法
在 2011 年至 2019 年间，我们分析了 13542 例接受初始手术（n=13542）或根治性 RT（剂量至少 6600cGy，n=145）治疗 OCSCC 的 cT1-2N0M0 患者的数据。为了考虑基线差异，我们采用倾向评分（PS）匹配，得到两组均衡的研究对象（初始手术组，n=580；根治性 RT 组，n=145）。
结果
在 PS 匹配之前，手术组的 5 年疾病特异性生存率（DSS）为 88%，RT 组为 58%。PS 匹配后，两组的 5 年 DSS 率分别为 86%和 58%。同样，PS 匹配前手术组的 5 年总生存率（OS）为 80%，RT 组为 36%，PS 匹配后分别为 73%和 36%。所有这些差异均具有统计学意义（p<0.0001）。多变量分析确定 RT 治疗、年龄较大、II 期肿瘤和更高的合并症负担为 DSS 和 OS 的独立危险因素。我们还检查了各种亚组（切缘≥5mm、切缘<5mm、阳性切缘、RT 联合化疗和 RT 单独治疗）的 5 年结局如下：DSS 为 89%/88%/79%/63%/51%，p<0.0001；OS 为 82%/79%/68%/39%/32%，p<0.0001。
结论
在台湾 cT1-2N0M0 OCSCC 患者中，完成根治性 RT 的比例（1.1%）极低。接受初始手术的患者和接受根治性 RT 的患者之间存在 30%的显著生存差异。有趣的是，即使是手术组中存在阳性手术切缘的患者，其生存也明显优于根治性 RT 组。
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