Abiri Arash, Liu Derek H, Nguyen Theodore V, Pang Jonathan C, Torabi Sina J, Kuan Edward C
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, United States.
Department of Neurological Surgery, University of California, Irvine, Orange, California, United States.
J Neurol Surg B Skull Base. 2024 Jan 9;85(Suppl 2):e153-e160. doi: 10.1055/a-2226-8414. eCollection 2024 Oct.
There is emerging evidence to suggest the role of induction chemotherapy (IC) in definitive management of locoregionally advanced sinonasal squamous cell carcinoma (SNSCC). We evaluated the influence of IC on survival and predictors of its use in SNSCC patients. The 2004 to 2017 National Cancer Database was queried for patients with locoregionally advanced SNSCC (T4/M0). Treatments were stratified into seven groups: definitive chemoradiation (CRT), IC with definitive CRT (IC + CRT), IC + CRT with salvage surgery (IC + CRT + Sx), definitive surgery (Sx), IC with definitive surgery (IC + Sx), definitive surgery with adjuvant radiation or CRT (Sx + ATx), or IC + Sx + ATx. Cox proportional-hazards regression assessed overall survival (OS) and logistic regression identified predictors of IC. Of 3,162 patients, 1,088 (34.4%) were female with a mean age of 63.4 ± 13.4 years. The 2- and 5-year OS rates were 58.6 and 42.0%, respectively. Compared with CRT, Sx + ATx (hazard ratio [HR]: 0.663; < 0.001), IC + Sx (HR: 0.606; = 0.005), or IC + Sx + ATx (HR: 0.468; = 0.001) exhibited reduced mortality. Among patients who were treated with definitive surgery, those receiving IC had additional OS benefit (all s < 0.05). Older age (odds ratio [OR]: 0.607; < 0.001), female sex (OR: 0.759; = 0.028), Black race (OR: 1.650; < 0.001, T4b stage (OR: 1.674; < 0.001), and higher N stage (OR: 1.395; < 0.001) were predictors of IC. IC prior to definitive surgery with or without adjuvant therapy exhibited the highest OS for locoregionally advanced SNSCC. Age, sex, race, and T/N staging were predictors of IC. Multimodal treatment regimens involving surgery as the primary modality may, therefore, provide the greatest therapeutic response.
越来越多的证据表明诱导化疗（IC）在局部晚期鼻窦鳞状细胞癌（SNSCC）的确定性治疗中发挥作用。我们评估了IC对SNSCC患者生存的影响及其使用的预测因素。
查询2004年至2017年国家癌症数据库中局部晚期SNSCC（T4/M0）患者。治疗分为七组：确定性放化疗（CRT）、IC联合确定性CRT（IC+CRT）、IC+CRT联合挽救性手术（IC+CRT+Sx）、确定性手术（Sx）、IC联合确定性手术（IC+Sx）、确定性手术联合辅助放疗或CRT（Sx+ATx）或IC+Sx+ATx。Cox比例风险回归评估总生存期（OS），逻辑回归确定IC的预测因素。
在3162例患者中，1088例（34.4%）为女性，平均年龄63.4±13.4岁。2年和5年OS率分别为58.6%和42.0%。与CRT相比，Sx+ATx（风险比[HR]：0.663；<0.001）、IC+Sx（HR：0.606；=0.005）或IC+Sx+ATx（HR：0.468；=0.001）的死亡率降低。在接受确定性手术的患者中，接受IC的患者有额外的OS获益（所有P值<0.05）。年龄较大（优势比[OR]：0.607；<0.001）、女性（OR：0.759；=0.028）、黑人种族（OR：1.650；<0.001）、T4b期（OR：1.674；<0.001）和更高的N分期（OR：1.395；<0.001）是IC的预测因素。
在有或没有辅助治疗的确定性手术前进行IC，对局部晚期SNSCC显示出最高的OS。年龄、性别、种族和T/N分期是IC的预测因素。因此，以手术为主要方式的多模式治疗方案可能提供最大的治疗反应。
