Ma Sung Jun, Zhu Simeng, Virk Jas, Koempel Andrew, Bhateja Priyanka, Gogineni Emile, Baliga Sujith, Konieczkowski David, Mitchell Darrion, Jhawar Sachin, Grecula John, Old Matthew, Rocco James, Bonomi Marcelo, Blakaj Dukagjin
Department of Radiation Oncology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo.
JAMA Netw Open. 2024 Dec 2;7(12):e2450272. doi: 10.1001/jamanetworkopen.2024.50272.
National Comprehensive Cancer Network guidelines recommend weekly cisplatin as an alternative concurrent systemic therapy for definitive chemoradiation in patients with head and neck cancer. However, the impact of different levels of adherence to weekly cisplatin on outcomes stratified by human papillomavirus p16 status remains unclear.
To evaluate the association between the number of weekly cisplatin cycles and outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, observational, single-institution cohort study at The Ohio State Comprehensive Cancer Center included patients with a diagnosis of nonmetastatic head and neck cancer between December 1, 2011, and March 30, 2020, who received chemoradiation. Data analysis was performed between March and May 2024.
A total of 5, 6, or 7 to 8 weekly cisplatin cycles.
The primary outcomes were overall survival (OS), progression-free survival (PFS), locoregional failure (LRF), and distant failure (DF). Cox multivariable analysis was performed for variables associated with OS and PFS, and Fine-Gray multivariable analysis was performed for variables associated with LRF and DF.
A total of 142 patients met the criteria (119 men [83.8%]; median [IQR] age, 59 [54-63] years). Median (IQR) follow-up was 46.8 (40.8-55.6) months. Among 92 patients with reasons for cisplatin interruption reported, the most common reason was low blood counts (42 patients [45.7%]). Those who missed weekly cisplatin cycles had worse OS (adjusted hazard ratio [aHR], 2.22; 95% CI, 1.19-4.17; P = .01) and PFS (aHR, 1.83; 95% CI, 1.06-3.15; P = .03) than those who received 7 to 8 cycles. Cancer control outcomes were comparable between these groups (LRF aHR, 0.53; 95% CI, 0.15-1.93; P = .34; DF aHR, 1.51; 95% CI, 0.60-3.82; P = .38). Patients with p16-negative tumors who missed weekly cisplatin cycles had worse OS (for every missing cisplatin cycle, aHR, 11.34, 1.51-84.94; P = .02) than those treated with 7 to 8 cycles. However, for those with p16-positive tumors, there were no statistically significant differences in OS between those who missed weekly cisplatin cycles vs others who received 7 to 8 cycles (aHR, 1.21; 95% CI, 0.47-3.14; P = .69).
In this cohort study of patients with head and neck cancer who received definitive chemoradiation, those with p16-negative tumors who missed weekly cisplatin cycles had lower OS than those who received 7 to 8 cycles, although OS was comparable between these groups for p16-positive tumors. Cytopenia represented the most common reason for cisplatin interruption.
美国国立综合癌症网络指南推荐将每周一次的顺铂作为头颈部癌患者确定性放化疗的一种替代同步全身治疗方案。然而，不同程度的每周顺铂治疗依从性对按人乳头瘤病毒p16状态分层的结局的影响仍不明确。
评估每周顺铂周期数与结局之间的关联。
设计、设置和参与者：这项在俄亥俄州立综合癌症中心开展的回顾性、观察性、单机构队列研究纳入了2011年12月1日至2020年3月30日期间诊断为非转移性头颈部癌且接受放化疗的患者。数据分析于2024年3月至5月进行。
总共5、6或7至8个每周一次的顺铂周期。
主要结局为总生存期（OS）、无进展生存期（PFS）、局部区域失败（LRF）和远处转移（DF）。对与OS和PFS相关的变量进行Cox多变量分析，对与LRF和DF相关的变量进行Fine-Gray多变量分析。
共有142例患者符合标准（119例男性[83.8%]；中位[四分位间距]年龄为59[54 - 63]岁）。中位（四分位间距）随访时间为46.8（40.8 - 55.6）个月。在报告有顺铂中断原因的92例患者中，最常见的原因是血细胞计数低（42例患者[45.7%]）。错过每周顺铂周期的患者的OS（调整后风险比[aHR]，2.22；95%置信区间[CI]，1.19 - 4.17；P = 0.01）和PFS（aHR，1.83；95% CI，1.06 - 3.15；P = 0.03）比接受7至8个周期治疗的患者更差。这些组之间的癌症控制结局相当（LRF的aHR，0.53；95% CI，0.15 - 1.93；P = 0.34；DF的aHR，1.51；95% CI，0.60 - 3.82；P = 0.38）。错过每周顺铂周期的p16阴性肿瘤患者的OS比接受7至8个周期治疗的患者更差（每错过一个顺铂周期，aHR，11.34，1.51 - 84.94；P = 0.02）。然而，对于p16阳性肿瘤患者，错过每周顺铂周期的患者与接受7至8个周期治疗的其他患者之间的OS无统计学显著差异（aHR，1.21；95% CI，0.47 - 3.14；P = 0.69）。
在这项对头颈部癌患者进行确定性放化疗的队列研究中，错过每周顺铂周期的p16阴性肿瘤患者的OS低于接受7至8个周期治疗的患者，尽管p16阳性肿瘤患者在这些组之间的OS相当。血细胞减少是顺铂中断的最常见原因。
Zotero 插件