Huang Lily, Patel Aman M, Haleem Afash, Brant Jason A, Maxwell Russell, Brody Robert M, Carey Ryan M
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Laryngoscope. 2025 Feb;135(2):729-740. doi: 10.1002/lary.31823. Epub 2024 Oct 8.
Investigate missed adjuvant therapy and associated disparities in overall survival (OS) for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC).
The 2010-2017 National Cancer Database was queried for patients with surgically resected HPV+ OPSCC. Indications for adjuvant radiotherapy (aRT) included pT3-4 classification, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins (PSM). Indication(s) for adjuvant chemoradiotherapy (aCRT) included pENE and/or PSM. Multivariable logistic and Cox regression models were implemented.
Of 5297 patients satisfying inclusion criteria, 4288 had indication(s) for aRT; 775 did not receive any adjuvant therapy and were considered as missing aRT. A total of 2234 patients had indication(s) for aCRT. Of these, 1383 (61.9%) received aCRT, 555 (24.8%) patients received aRT alone and were considered as having missed aCRT, and 296 (13.2%) did not receive any adjuvant therapy. Missed aRT and missed aCRT were each associated with age, treatment facility type, pN classification, and surgical margin status (p < 0.015). Among patients with indication(s) for aRT alone, OS of those receiving no adjuvant therapy, aRT alone, and aCRT was 90.0%, 94.8%, and 93.4%, respectively (p = 0.080). Among patients with indication(s) for aCRT, those receiving aRT alone and aCRT had similar OS (89.0% vs. 86.6%, p = 0.357) which was superior to receiving no adjuvant therapy (74.9%, p < 0.001). These patterns in OS persisted on multivariable Cox regression.
Among patients with HPV+ OPSCC and indication(s) for aRT, missed aRT was not associated with worse OS. For patients with indication(s) for aCRT, aRT alone was associated with similar OS as aCRT.
3 Laryngoscope, 135:729-740, 2025.
调查人乳头瘤病毒相关（HPV+）口咽鳞状细胞癌（OPSCC）患者辅助治疗的遗漏情况及总生存期（OS）的相关差异。
在2010 - 2017年国家癌症数据库中查询接受手术切除的HPV+ OPSCC患者。辅助放疗（aRT）的指征包括pT3 - 4分期、pN2 - 3分期、脉管侵犯、病理淋巴结外侵犯（pENE）和/或手术切缘阳性（PSM）。辅助放化疗（aCRT）的指征包括pENE和/或PSM。实施多变量逻辑回归和Cox回归模型。
在5297例符合纳入标准的患者中，4288例有aRT指征；775例未接受任何辅助治疗，被视为遗漏aRT。共有2234例患者有aCRT指征。其中，1383例（61.9%）接受了aCRT，555例（24.8%）患者仅接受了aRT，被视为遗漏aCRT，296例（13.2%）未接受任何辅助治疗。遗漏aRT和遗漏aCRT均与年龄、治疗机构类型、pN分期和手术切缘状态相关（p < 0.015）。在仅具有aRT指征的患者中，未接受辅助治疗、仅接受aRT和接受aCRT的患者的OS分别为90.0%、94.8%和93.4%（p = 0.080）。在具有aCRT指征的患者中，仅接受aRT和接受aCRT的患者的OS相似（89.0%对86.6%，p = 0.357），均优于未接受辅助治疗的患者（74.9%，p < 0.001）。这些OS模式在多变量Cox回归中持续存在。
在有aRT指征的HPV+ OPSCC患者中，遗漏aRT与较差的OS无关。对于有aCRT指征的患者，仅接受aRT与接受aCRT的OS相似。
3 喉镜，135:729 - 740，2025年。
