Yan Wenbin, Ou Xiaomin, Shen Chunying, Hu Chaosu
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Shanghai, China.
J Natl Cancer Cent. 2022 Jun 19;2(3):188-194. doi: 10.1016/j.jncc.2022.06.001. eCollection 2022 Sep.
Radiotherapy following primary operation is strongly recommended for salivary gland carcinomas (SGCs) with adverse features. The interval between surgery and the initiation of radiotherapy (SRT) varied and a prolonged SRT may cause failure of cancer treatment. However, the association of SRT with survival is unclear in major SGCs.
This retrospective study included a total of 346 patients who underwent radiotherapy after the primary operation from Fudan University Shanghai Cancer Center from 2005 to 2020. The best cutoff value of the SRT was determined by the maximum log-rank statistic method. The primary endpoint of the study was overall survival (OS). Correlations between variables and OS were conducted by the univariable analysis using the Log-rank method, and a multivariate Cox proportional hazards regression was performed to identify the independent prognostic factors associated with OS. The estimated survival rates were captured using the Kaplan-Meier method.
With a median follow-up time of 70.31 months, the estimated 5-year OS, LRFS, and DMFS were 83.3%, 80.1%, and 75.9%, respectively. The cutoff value for SRT was 8.5 weeks, while age, T stage, N stage, perineural invasion (PNI), pathological aggression, chemotherapy, and SRT were associated with OS in the univariable analysis. The Cox regression analysis demonstrated that older age ( < 0.001), T3-4 tumors ( = 0.007), positive N stage ( < 0.001), pathological aggression ( = 0.014), and longer SRT ( = 0.009) were independent prognostic factors for major SGCs. Using the stratification model, we observed that delay in the SRT was associated with worse OS ( = 0.006) in the high-risk group, whereas no significant difference was observed in the low-risk subgroup ( = 0.61).
The delay in the initiation of postoperative radiotherapy may be a prognostic factor for patients with major SGCs. It was suggested that radiotherapy should be delivered within 8.5 weeks following the operation, especially for patients with ≥2 risk factors, including older age, high pathological aggression, T3-4 tumors, and positive N stage.
对于具有不良特征的涎腺癌（SGC），强烈建议在初次手术后进行放疗。手术与放疗开始（SRT）之间的间隔各不相同，延长SRT可能导致癌症治疗失败。然而，在主要的SGC中，SRT与生存率之间的关联尚不清楚。
这项回顾性研究共纳入了2005年至2020年在复旦大学附属肿瘤医院接受初次手术后放疗的346例患者。通过最大对数秩统计方法确定SRT的最佳临界值。研究的主要终点是总生存期（OS）。采用对数秩方法进行单变量分析，以探讨各变量与OS之间的相关性，并进行多变量Cox比例风险回归分析，以确定与OS相关的独立预后因素。采用Kaplan-Meier方法计算估计生存率。
中位随访时间为70.31个月，估计5年OS、局部区域无复发生存率（LRFS）和远处无转移生存率（DMFS）分别为83.3%、80.1%和75.9%。SRT的临界值为8.5周，在单变量分析中，年龄、T分期、N分期、神经周围侵犯（PNI）、病理侵袭性、化疗和SRT与OS相关。Cox回归分析表明，年龄较大（<0.001）、T3-4期肿瘤（=0.007）、N分期阳性（<0.001）、病理侵袭性（=0.014）和SRT时间较长（=0.009）是主要SGC的独立预后因素。使用分层模型，我们观察到在高危组中，SRT延迟与较差的OS相关（=0.006），而在低危亚组中未观察到显著差异（=0.61）。
术后放疗开始延迟可能是主要SGC患者的一个预后因素。建议在术后8.5周内进行放疗，特别是对于具有≥2个危险因素的患者，包括年龄较大、病理侵袭性高、T3-4期肿瘤和N分期阳性。
