Patel Aman M, Haleem Afash, Revercomb Lucy, Brant Jason A, Rajasekaran Karthik, Sun Lova L, Brody Robert M, Carey Ryan M
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.
Laryngoscope Investig Otolaryngol. 2024 Sep 14;9(5):e70000. doi: 10.1002/lio2.70000. eCollection 2024 Oct.
To investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC).
The 2006-2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan-Meier, and multivariable Cox proportional hazards regression models were implemented.
Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively ( < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) ( < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54-6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25-6.32, < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38-0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21-0.66) were associated with higher OS ( < .005). Immunotherapy (aHR 0.48, 95% CI 0.28-0.81, = .006) was also independently associated with higher OS.
A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.Level of evidence: 4.
探讨临床远处转移（cM1）口腔鳞状细胞癌（OCSCC）的原发灶手术切除及总生存期（OS）。
查询2006 - 2018年国家癌症数据库中接受化疗的cM1 OCSCC患者。采用二元逻辑回归、Kaplan - Meier法和多变量Cox比例风险回归模型。
278例符合纳入标准的患者中，139例（50.0%）仅接受化疗，80例（28.8%）接受放化疗，25例（9.0%）接受手术切除+辅助化疗，34例（12.2%）接受手术切除+辅助放化疗；5年总生存率分别为9.4%、15.2%、8.3%和23.8%（P<0.001）。与未接受手术切除的患者相比，接受手术切除的患者更常接受放疗（57.6%对36.5%），但接受多药化疗的频率较低（40.7%对74.4%）（P<0.005）。21例（36.2%）接受手术切除的患者手术切缘阳性。学术机构（校正比值比[aOR] 3.19，95%可信区间[CI] 1.54 - 6.62）和Charlson - Deyo合并症评分≥1（aOR 2.82，95% CI 1.25 - 6.32，P<0.025）与接受手术切除的几率增加相关。与单纯化疗相比，放化疗（校正风险比[aHR] 0.56，95% CI 0.38 - 0.83）和手术切除+辅助放化疗（aHR 0.37，95% CI 0.21 - 0.66）与更高的总生存期相关（P<0.005）。免疫治疗（aHR 0.48，95% CI 0.28 - 0.81，P = 0.006）也与更高的总生存期独立相关。
少数cM1 OCSCC患者接受了原发灶手术切除。尽管手术切缘阳性率高，但手术切除+辅助放化疗与单纯化疗、放化疗或手术切除+辅助化疗相比，总生存期更高。确定性局部治疗可能使部分cM1 OCSCC患者受益。证据级别：4级。
