Elkoumi Ahmed, Elkoumi Omar, Elkasaby Mohamed Hamouda, Khitiy Huzifa, Elbairy Mariam Khaled, Tawfik Ahmed, Habib Omar K, Shaalan Abeer
Faculty of Oral and Dental Medicine, Egyptian Russian University (ERU), Badr City, Cairo, Egypt.
Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
Oral Maxillofac Surg. 2025 Jan 9;29(1):27. doi: 10.1007/s10006-024-01316-0.
The primary objective of this study was to assess the benefit of cancer-directed surgery (CDS) on both overall survival (OS) and cancer-specific survival (CSS) of patients with malignant major salivary gland cancers (MMSGCs). The secondary objective was to explore the benefits of adjuvant therapy on the survival outcomes of these patients.
Patients diagnosed with MMSGC were extracted from the SEER database and subsequently categorized into two cohorts: CDS and non-CDS. Propensity score matching (PSM) was used to mitigate confounding variables. The survival benefit associated with CDS was evaluated using Kaplan-Meier analysis, log-rank tests, and Cox proportional hazard models. Furthermore, the impact of adjuvant radiotherapy and chemotherapy was explored within the CDS subgroup.
A total of 7,029 patients with MMSGC were included. PSM was performed and resulted in a matched cohort between both groups, including 595 patients in each group. Multivariable Cox proportional hazard indicated that patients who received CDS had better OS (HR: 0.45, 95% CI [0.39 to 0.52], P < 0.001) and CSS (HR: 0.46, 95% CI [0.40 to 0.52], P < 0.001). The 5- and 10-year OS for the CDS group was 42% (95% CI, 38 - 46%), and 25% (95% CI, 21 - 29%) consecutively, while the 5- and 10-year OS for the non-CDS group was 20% (95% CI, 17 - 24%), and 12% (95% CI, 9.7 - 16%) consecutively. Moreover, patients with younger age, localized tumors, and lower TNM stage could benefit more from CDS. Radiotherapy as adjuvant therapy was found to be beneficial (HR: 0.69, 95% CI [0.55-0.85], p < 0.001), while chemotherapy could not significantly benefit these patients.
CDS improved the OS and CSS survival in MMSGC patients. Specific patient subgroups seemed to have a superior benefit from CDS. Adjuvant radiotherapy could help enhance the survival outcomes of these patients while chemotherapy could not.
本研究的主要目的是评估癌症定向手术（CDS）对恶性大唾液腺癌（MMSGC）患者总生存期（OS）和癌症特异性生存期（CSS）的益处。次要目的是探讨辅助治疗对这些患者生存结局的益处。
从SEER数据库中提取诊断为MMSGC的患者，随后将其分为两个队列：CDS组和非CDS组。采用倾向评分匹配（PSM）来减轻混杂变量的影响。使用Kaplan-Meier分析、对数秩检验和Cox比例风险模型评估与CDS相关的生存益处。此外，在CDS亚组中探讨辅助放疗和化疗的影响。
共纳入7029例MMSGC患者。进行了PSM，两组之间形成了匹配队列，每组包括595例患者。多变量Cox比例风险分析表明，接受CDS的患者具有更好的OS（HR：0.45，95%CI[0.39至0.52]，P<0.001）和CSS（HR：0.46，95%CI[0.40至0.52]，P<0.001）。CDS组的5年和10年OS分别为42%（95%CI，38-46%）和25%（95%CI，21-29%），而非CDS组的5年和10年OS分别为20%（95%CI，17-24%）和12%（95%CI，9.7-16%）。此外，年龄较小、肿瘤局限且TNM分期较低的患者从CDS中获益更多。发现辅助放疗有益（HR：0.69，95%CI[0.55-0.85]，p<0.001），而化疗对这些患者无显著益处。
CDS改善了MMSGC患者的OS和CSS生存率。特定患者亚组似乎从CDS中获益更大。辅助放疗有助于提高这些患者的生存结局，而化疗则不能。
