辅助治疗和特定辐射剂量对有结外侵犯的台湾口腔癌患者的预后意义：一项全国性队列研究。
Prognostic significance of adjuvant therapy and specific radiation dosages in Taiwanese patients with oral cavity cancer and extra-nodal extension: a nationwide cohort study.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Taoyuan, Taiwan, ROC.
出版信息
BMC Cancer. 2024 Oct 25;24(1):1320. doi: 10.1186/s12885-024-13048-1.
BACKGROUND
The evidence for adjuvant chemoradiotherapy (CRT) of oral cavity squamous cell carcinoma (OCSCC) with extra-nodal extension (ENE) in National Comprehensive Cancer Network (NCCN) guidelines is derived from patients with head and neck cancer. The guidelines further suggest a radiation dose ranging from 6000 to 6600 cGy. In this nationwide study, we sought to evaluate the prognostic significance of adjuvant therapy and the specific radiation dosage in Taiwanese patients with pure OCSCC and ENE.
METHODS
A retrospective analysis of 1577 OCSCC patients with ENE who underwent resection and received adjuvant CRT or radiotherapy (RT) between January 2011 and December 2020 was conducted.
RESULTS
Multivariable analysis revealed that adjuvant RT, more than four pathologically positive nodes, and radiation dosage below 6000 cGy were independent risk factors for unfavorable 5-year disease-specific survival (DSS) and overall survival (OS). Comparing patients who received CRT (n = 1453) to those treated with RT (n = 124) before and after propensity score (PS) matching, the 5-year outcomes were as follows: before PS matching, DSS (54% versus 30%, p < 0.0001), OS (42% versus 18%, p < 0.0001); after PS matching (n = 111 in each group), DSS (52% versus 30%, p = 0.0016), OS (38% versus 21%, p = 0.0019). For patients who underwent CRT, the 5-year outcomes for different radiation dose groups (6600 - 7000 cGy, n = 1155 versus 6000 - 6500 cGy, n = 199) were as follows: before PS matching, DSS (52% versus 54%, p = 0.1904), OS (43% versus 46%, p = 0.1610); after PS matching (n = 199 in each group), DSS (55% versus 54%, p = 0.8374), OS (46.5% versus 46.3%, p = 0.7578).
CONCLUSIONS
For OCSCC patients with ENE, our study shows CRT improved survivals than RT alone, underscoring the clinical significance of chemotherapy. Patients undergoing CRT with irradiation doses ranging from 6000 to 6500 cGy exhibited comparable survival outcomes to those receiving doses of 6600-7000 cGy. This observation suggests that irradiation doses exceeding the 6600 cGy may not confer the survival advantage in these patients. Further research is needed to confirm our results and explore the optimal irradiation dose for managing these patients.
背景
美国国家综合癌症网络（NCCN）指南中关于口腔鳞状细胞癌（OCSCC）伴淋巴结外侵犯（ENE）的辅助放化疗（CRT）证据来源于头颈部癌症患者。该指南进一步建议放疗剂量范围为 6000 至 6600cGy。在这项全国性研究中，我们旨在评估辅助治疗和特定放疗剂量在台湾纯 OCSCC 和 ENE 患者中的预后意义。
方法
回顾性分析了 2011 年 1 月至 2020 年 12 月期间接受切除术和辅助 CRT 或放疗（RT）的 1577 例伴有 ENE 的 OCSCC 患者。
结果
多变量分析显示，辅助 RT、病理阳性淋巴结超过 4 个和放疗剂量低于 6000cGy 是无病特异性生存率（DSS）和总生存率（OS）不良的独立危险因素。比较 CRT（n=1453）和 RT（n=124）治疗的患者，在倾向评分（PS）匹配前后，5 年结果如下：PS 匹配前，DSS（54%比 30%，p<0.0001），OS（42%比 18%，p<0.0001）；PS 匹配后（每组 n=111），DSS（52%比 30%，p=0.0016），OS（38%比 21%，p=0.0019）。对于接受 CRT 的患者，不同放疗剂量组（6600-7000cGy，n=1155 与 6000-6500cGy，n=199）的 5 年结果如下：PS 匹配前，DSS（52%比 54%，p=0.1904），OS（43%比 46%，p=0.1610）；PS 匹配后（每组 n=199），DSS（55%比 54%，p=0.8374），OS（46.5%比 46.3%，p=0.7578）。
结论
对于伴有 ENE 的 OCSCC 患者，本研究表明 CRT 比单独 RT 改善生存，强调了化疗的临床意义。接受 6000 至 6500cGy 放疗的 CRT 患者与接受 6600-7000cGy 放疗的患者具有相似的生存结果。这一观察结果表明，对于这些患者，超过 6600cGy 的照射剂量可能不会带来生存优势。需要进一步研究来证实我们的结果，并探讨管理这些患者的最佳照射剂量。
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