Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
Cancer Med. 2024 Jun;13(12):e7213. doi: 10.1002/cam4.7213.
Elective tracheotomy is commonly performed in resected oral squamous cell carcinoma (OCSCC) to maintain airway patency. However, the indications for this procedure vary among surgeons. This nationwide study evaluated the impact of tracheotomy on both the duration of in-hospital stay and long-term survival outcomes in patients with OCSCC.
A total of 18,416 patients with OCSCC were included in the analysis, comprising 7981 patients who underwent elective tracheotomy and 10,435 who did not. The primary outcomes assessed were 5-year disease-specific survival (DSS) and overall survival (OS). To minimize potential confounding factors, a propensity score (PS)-matched analysis was performed on 4301 patients from each group. The duration of hospital stay was not included as a variable in the PS-matched analysis.
Prior to PS matching, patients with tracheotomy had significantly lower 5-year DSS and OS rates compared to those without (71% vs. 82%, p < 0.0001; 62% vs. 75%, p < 0.0001, respectively). Multivariable analysis identified tracheotomy as an independent adverse prognostic factor for 5-year DSS (hazard ratio = 1.10 [1.03-1.18], p = 0.0063) and OS (hazard ratio = 1.10 [1.04-1.17], p = 0.0015). In the PS-matched cohort, the 5-year DSS was 75% for patients with tracheotomy and 76% for those without (p = 0.1488). Five-year OS rates were 66% and 67%, respectively (p = 0.0808). Prior to PS matching, patients with tracheotomy had a significantly longer mean hospital stay compared to those without (23.37 ± 10.56 days vs. 14.19 ± 8.34 days; p < 0.0001). Following PS matching, the difference in hospital stay duration between the two groups remained significant (22.34 ± 10.25 days vs. 17.59 ± 9.54 days; p < 0.0001).
While elective tracheotomy in resected OCSCC patients may not significantly affect survival, it could be associated with prolonged hospital stays.
择期行气管切开术通常用于切除的口腔鳞状细胞癌（OCSCC）患者以维持气道通畅。然而，该手术的适应证在不同的外科医生之间存在差异。本项全国性研究评估了气管切开术对 OCSCC 患者住院时间长短和长期生存结果的影响。
共纳入 18416 例 OCSCC 患者，其中 7981 例行择期气管切开术，10435 例未行气管切开术。主要观察指标为 5 年疾病特异性生存率（DSS）和总生存率（OS）。为了最小化潜在的混杂因素，对每组的 4301 例患者进行了倾向评分（PS）匹配分析。PS 匹配分析中未将住院时间作为变量。
在 PS 匹配之前，行气管切开术的患者的 5 年 DSS 和 OS 率显著低于未行气管切开术的患者（71% vs. 82%，p<0.0001；62% vs. 75%，p<0.0001）。多变量分析确定气管切开术是 5 年 DSS（风险比=1.10[1.03-1.18]，p=0.0063）和 OS（风险比=1.10[1.04-1.17]，p=0.0015）的独立不良预后因素。在 PS 匹配队列中，行气管切开术的患者 5 年 DSS 为 75%，未行气管切开术的患者为 76%（p=0.1488）。5 年 OS 率分别为 66%和 67%（p=0.0808）。在 PS 匹配之前，行气管切开术的患者的平均住院时间明显长于未行气管切开术的患者（23.37±10.56 天 vs. 14.19±8.34 天；p<0.0001）。PS 匹配后，两组间住院时间的差异仍有统计学意义（22.34±10.25 天 vs. 17.59±9.54 天；p<0.0001）。
尽管择期行气管切开术在切除的 OCSCC 患者中可能不会显著影响生存，但可能与住院时间延长有关。
