Villemure-Poliquin Noémie, Fu Rui, Gaebe Karolina, Kwon Jin, Cohen Marc, Ruel Marianne, Ayoo Kennedy, Bayley Andrew, Galapin Madette, Hallet Julie, Eskander Antoine
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Laryngoscope. 2025 May;135(5):1563-1570. doi: 10.1002/lary.31990. Epub 2025 Jan 2.
To evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).
A systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.
Studies assessing the impact of delayed PORT in adult HNC patients were included. A total of 11,171 titles and abstracts were screened, with 52 studies meeting the inclusion criteria. Data were extracted, and a pooled random-effects analysis was performed. The primary outcome was overall survival (OS), comparing patients receiving timely PORT (within 42 days) to those with delays.
Of the included studies, 31 were conducted in the United States, with 16 using the National Cancer Database (NCDB). Patients who did not receive PORT within 42 days had a 4% increase in mortality (adjusted Hazard Ratio [aHR]: 1.04 [1.03-1.06]; I = 78%; N = 254,189; 16 studies). Excluding time-overlapping NCDB-based studies, the OS benefit for timely treatment persisted (aHR: 1.10 [1.01-1.20]; I = 39%; N = 52,003; 5 studies).
Initiating PORT within 42 days is significantly associated with decreased mortality in HNC patients, reinforcing CoC recommendations. However, more research is needed to understand the relationship between different time cutoffs and outcomes, and to identify factors contributing to PORT delays. Future studies should explore the impact of treatment delays on patient-centered outcomes, such as Quality of Life (QoL).
NA Laryngoscope, 135:1563-1570, 2025.
评估延迟术后放疗（PORT）对头颈癌（HNC）患者总生存期（OS）的影响。
通过检索MEDLINE、Embase、CENTRAL、Web of Science和CINAHL数据库进行系统评价和荟萃分析。
纳入评估延迟PORT对成年HNC患者影响的研究。共筛选了11171篇标题和摘要，52项研究符合纳入标准。提取数据并进行汇总随机效应分析。主要结局是总生存期（OS），比较接受及时PORT（42天内）的患者与延迟PORT的患者。
在纳入的研究中，31项在美国进行，其中16项使用了国家癌症数据库（NCDB）。在42天内未接受PORT的患者死亡率增加4%（调整后风险比[aHR]：1.04[1.03 - 1.06]；I² = 78%；N = 254189；16项研究）。排除基于NCDB的时间重叠研究后，及时治疗的OS获益仍然存在（aHR：1.10[1.01 - 1.20]；I² = 39%；N = 52003；5项研究）。
在42天内开始PORT与HNC患者死亡率降低显著相关，强化了美国放射肿瘤学会（CoC）的建议。然而，需要更多研究来了解不同时间截断点与结局之间的关系，并确定导致PORT延迟的因素。未来的研究应探讨治疗延迟对以患者为中心的结局（如生活质量[QoL]）的影响。
NA 《喉镜》，135:1563 - 1570，2025年。
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