Wihlidal Jacob, Esemezie Alex O, Huang Shao Hui, Watson Erin, Gilbert Ralph W, Waldron John, Gullane Patrick J, Hope Andrew, Irish Jonathan C, O'Sullivan Brian, Chepeha Douglas B, Kim John J H, Brown Dale, Cho B C John, Witterick Ian J, Monteiro Eric, Davies Joel C, Ringash Jolie, Goldstein David P, Bratman Scott, Bayley Andrew, de Almeida John R, Chan Timothy C Y, Hosni Ali, Yao Christopher M K L
Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
Ann Surg Oncol. 2025 Feb;32(2):1270-1279. doi: 10.1245/s10434-024-16385-4. Epub 2024 Oct 28.
Multidisciplinary care is paramount in patient-specific decision making, especially as pertaining to oral cavity squamous cell cancer (OCSCC) treatment. Protracted surgery-postoperative-radiation (S-PORT) has a detrimental impact on OCSCC patients' outcomes. This study examined the impact of surgeon-radiation oncologist dyads on the treatment of OCSCC, focusing on S-PORT interval and disease specific outcomes.
All OCSCC patients treated in a tertiary cancer center between 2009 to 2017 were included. Patients were categorized into "dyad" and "nondyad" groups defined as whether they were treated by a paired surgeon-radiation oncology team with joint multidisciplinary clinic or shared >30% patient volumes. Univariate and multivariate logistic regression were performed to identify factors associated with a prolonged S-PORT time interval (≥8 weeks). Overall survival and locoregional recurrence were estimated and compared.
A total of 444 OCSCC were eligible. Treatment by a dyad was significantly less likely associated with S-PORT ≥ 8 weeks (odds ratio [OR]: 0.65; 95% confidence interval [CI] 0.44-0.96; p = 0.03). Obtaining pre-operative radiation oncology consultation also decreased the S-PORT interval. Advanced T-category and the need for free tissue flap reconstruction increased the likelihood of prolonged S-PORT on univariate but not multivariate analysis. No significant differences were observed in overall survival or locoregional recurrence by dyad status nor S-PORT (p > 0.05).
Surgeon-radiation oncology dyads significantly minimized time from surgery to postoperative radiation in OCSCC. While improvement in overall survival or locoregional recurrence was not observed, these findings support close knit collaborative multidisciplinary treatment care models, including dyad-based care.
多学科护理在针对患者的决策制定中至关重要，尤其是在口腔鳞状细胞癌（OCSCC）治疗方面。长期的手术-术后-放疗（S-PORT）对OCSCC患者的预后有不利影响。本研究探讨了外科医生-放疗肿瘤学家二元组对OCSCC治疗的影响，重点关注S-PORT间隔和疾病特异性结局。
纳入2009年至2017年在三级癌症中心接受治疗的所有OCSCC患者。患者被分为“二元组”和“非二元组”，定义为他们是否由配对的外科医生-放疗肿瘤学团队进行治疗，该团队设有联合多学科诊所或共享超过30%的患者量。进行单因素和多因素逻辑回归分析，以确定与延长的S-PORT时间间隔（≥8周）相关的因素。估计并比较总生存期和局部区域复发情况。
共有444例OCSCC患者符合条件。由二元组进行治疗与S-PORT≥8周的相关性显著降低（比值比[OR]：0.65；95%置信区间[CI] 0.44 - 0.96；p = 0.03）。获得术前放疗肿瘤学会诊也缩短了S-PORT间隔。在单因素分析中，晚期T分期和游离组织瓣重建的需求增加了S-PORT延长的可能性，但在多因素分析中并非如此。二元组状态或S-PORT在总生存期或局部区域复发方面未观察到显著差异（p > 0.05）。
外科医生-放疗肿瘤学二元组显著缩短了OCSCC患者从手术到术后放疗的时间。虽然未观察到总生存期或局部区域复发有所改善，但这些发现支持紧密协作的多学科治疗护理模式，包括基于二元组的护理。
