cT4b期鼻窦非鳞状细胞癌的手术切除与总生存期
Surgical resection and overall survival in cT4b sinonasal non-squamous cell carcinoma.
作者信息
Patel Aman M, Haleem Afash, Revercomb Lucy, Brant Jason A, Kohanski Michael A, Adappa Nithin D, Palmer James N, Douglas Jennifer E, Carey Ryan M
机构信息
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.
出版信息
Laryngoscope Investig Otolaryngol. 2024 Oct 23;9(5):e70025. doi: 10.1002/lio2.70025. eCollection 2024 Oct.
OBJECTIVE
Surgical resection is associated with higher overall survival (OS) than definitive radiotherapy (RT) or chemoradiotherapy (CRT) in cT4b sinonasal squamous cell carcinoma (SCC). Our study investigates the survival benefit of surgical resection in cT4b sinonasal non-SCC.
METHODS
The 2004 to 2019 National Cancer Database was queried for patients with cT4b sinonasal non-SCC undergoing definitive treatment with (1) surgical resection + additional therapy (RT, chemotherapy, or both), (2) RT alone, or (3) CRT. Surgical resection + additional therapy and definitive RT/CRT were compared with Kaplan-Meier and multivariable Cox regression models.
RESULTS
Of 629 patients satisfying inclusion criteria, 513 (81.6%) underwent surgical resection + additional therapy and 116 (18.4%) underwent definitive RT/CRT. The most frequent histologic types were undifferentiated carcinoma (23.7%), adenoid cystic carcinoma (22.6%), and adenocarcinoma (20.7%). Few patients presented with clinical nodal metastasis (15.7%). There were 4 (0.8%) mortalities within 90 days of surgical resection. Patients undergoing surgical resection with positive surgical margins had higher 5-year OS than those undergoing definitive RT/CRT (56.3% vs. 39.4%, = .039) and similar 5-year OS as those with negative margins (56.3% vs. 63.9%, = .059). Patients undergoing neoadjuvant chemotherapy had similar 5-year OS as those undergoing definitive RT/CRT (60.9% vs. 39.5%, = .053). Age at diagnosis, tumor diameter, and surgical resection + additional therapy (aHR 0.64, 95% CI 0.45-0.91) were associated with OS ( < .05).
CONCLUSION
Surgical resection + additional therapy was associated with higher OS than definitive RT/CRT in cT4b sinonasal non-SCC. Surgical resection may benefit select patient with cT4b sinonasal non-SCC.
LEVEL OF EVIDENCE
目的
在cT4b期鼻窦鳞状细胞癌（SCC）中，手术切除与比根治性放疗（RT）或放化疗（CRT）更高的总生存期（OS）相关。我们的研究调查了手术切除对cT4b期鼻窦非SCC患者的生存获益。
方法
查询2004年至2019年国家癌症数据库中接受以下确定性治疗的cT4b期鼻窦非SCC患者：（1）手术切除+额外治疗（RT、化疗或两者），（2）单纯RT，或（3）CRT。采用Kaplan-Meier法和多变量Cox回归模型比较手术切除+额外治疗与根治性RT/CRT。
结果
在629例符合纳入标准的患者中，513例（81.6%）接受了手术切除+额外治疗，116例（18.4%）接受了根治性RT/CRT。最常见的组织学类型为未分化癌（23.7%）、腺样囊性癌（22.6%）和腺癌（20.7%）。很少有患者出现临床淋巴结转移（15.7%）。手术切除后90天内有4例（0.8%）死亡。手术切缘阳性的手术切除患者的5年总生存期高于接受根治性RT/CRT的患者（56.3%对39.4%，P = 0.039），与切缘阴性的患者5年总生存期相似（56.3%对63.9%，P = 0.059）。接受新辅助化疗的患者的5年总生存期与接受根治性RT/CRT的患者相似（60.9%对39.5%，P = 0.053）。诊断时年龄、肿瘤直径和手术切除+额外治疗（风险比0.64，95%可信区间0.45-0.91）与总生存期相关（P<0.05）。
结论
在cT4b期鼻窦非SCC中，手术切除+额外治疗与比根治性RT/CRT更高的总生存期相关。手术切除可能使部分cT4b期鼻窦非SCC患者获益。
证据级别
4级。
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