Lee Kue T, Kleinbub Duncan, Gelves Camilo R
Department of Biology, Emory University, Atlanta, Georgia, United States.
Department of Biology, University of Georgia, Athens, Georgia, United States.
J Neurol Surg B Skull Base. 2023 Dec 27;85(Suppl 2):e64-e72. doi: 10.1055/a-2201-8466. eCollection 2024 Oct.
Stage cT4a and cT4b squamous cell carcinomas (SCCa) typically require multimodal treatment with adjuvant or neoadjuvant therapy. This study aims to evaluate the impact of different treatment modalities on survival outcomes in patients with stage cT4a-b SCCa exclusively of the maxillary sinus. A multivariate survival analysis was conducted, evaluating treatment modalities for patients diagnosed between 2004 and 2020 utilizing the National Cancer Database. Cox hazard regression was performed for variables. The study identified a total of 1,788 patients with SCCa of the maxillary sinuses, of which 71.2% were cT4a. Increasing age, Charlson-Deyo score ≥ 1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Multivariate analysis revealed that neoadjuvant treatment exhibited the lowest hazard ratio ([HR]: 0.574, 95% confidence interval [CI]: 0.370-0.892) across the entire cohort (cT4a-b). Neoadjuvant treatment plus surgery, adjuvant treatment plus surgery, and surgery alone demonstrated the highest adjusted 5-year survival for cT4a-b tumors. On the other hand, radiation alone exhibited the highest HR (1.939, 95% CI: 1.555-2.418) in multivariate analysis and the lowest adjusted 5-year survival. Multimodal treatment of advanced stage maxillary SCCa has a variable effect on outcomes by tumor stage. Our findings suggest that surgery plus neoadjuvant and surgery plus adjuvant treatment are associated with higher rates of survival. Increasing age, Charlson-Deyo score ≥ 1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Further randomized controlled trials are required to quantify the therapeutic benefit of these treatments on survival and organ sparing in advanced stage disease.
cT4a期和cT4b期鳞状细胞癌（SCCa）通常需要辅助或新辅助治疗的多模式治疗。本研究旨在评估不同治疗方式对上颌窦单纯cT4a - b期SCCa患者生存结局的影响。
进行了多变量生存分析，利用国家癌症数据库评估2004年至2020年期间诊断的患者的治疗方式。对变量进行了Cox风险回归分析。
该研究共纳入1788例上颌窦SCCa患者，其中71.2%为cT4a期。年龄增加、Charlson - Deyo评分≥1以及未分化/间变分级与较差的生存率相关。多变量分析显示，在整个队列（cT4a - b）中，新辅助治疗的风险比最低（[HR]：0.574，95%置信区间[CI]：0.370 - 0.892）。新辅助治疗加手术、辅助治疗加手术以及单纯手术在cT4a - b期肿瘤中显示出最高的调整后5年生存率。另一方面，在多变量分析中，单纯放疗的HR最高（1.939，95% CI：1.555 - 2.418），调整后5年生存率最低。
晚期上颌窦SCCa的多模式治疗对不同肿瘤分期的结局有不同影响。我们的研究结果表明，手术加新辅助治疗和手术加辅助治疗与较高的生存率相关。年龄增加、Charlson - Deyo评分≥1以及未分化/间变分级与较差的生存率相关。需要进一步的随机对照试验来量化这些治疗对晚期疾病生存和器官保留的治疗益处。
