Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes
Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes
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DOI：
10.1016/j.ijrobp.2015.03.004
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发表时间：
2015-07-01
影响因子：
7
通讯作者：
Lin, Alexander
中科院分区：
文献类型：
--
作者：
Grover, Surbhi;Swisher-McClure, Samuel;Lin, Alexander
目的：使用大型国家癌症登记处检查T4 a喉癌背景下全喉切除术（TL）和喉保留放疗（LP-CRT）的实践模式并比较生存结果。方法和材料：使用国家癌症数据库，从2003年到2006年，我们确定了969例T4 a喉鳞状细胞癌患者，他们接受了初始TL加辅助治疗的确定性治疗治疗或LP-CRT。单变量和多变量逻辑回归分析用于评估手术的预测因素。采用Kaplan-Meier法、倾向评分校正法和治疗加权考克斯比例风险逆概率法比较生存结局。进行敏感性分析，以占未测量的confronder.Results：共616例（64%）接受LP-CRT，353（36%）接受TL。在多变量逻辑回归分析中，晚期淋巴结疾病患者接受TL的可能性较低（N2对N 0，26.6%对43.4%，比值比[OR] 0.52，95%可信区间[CI] 0.37-0.73; N3 vs N 0，19.1% vs 43.4%，OR 0.23，95% CI 0.07-0.77），而在高病例量机构接受治疗的患者更有可能接受TL（46.1% vs 31.5%，OR 1.78，95% CI 1.27-2.48）。TL与LP的中位生存期分别为61个月与39个月（P
Purpose: To examine practice patterns and compare survival outcomes between total laryngectomy (TL) and larynx preservation chemoradiation (LP-CRT) in the setting of T4a larynx cancer, using a large national cancer registry.Methods and Materials: Using the National Cancer Database, we identified 969 patients from 2003 to 2006 with T4a squamous cell larynx cancer receiving definitive treatment with either initial TL plus adjuvant therapy or LP-CRT. Univariate and multivariable logistic regression were used to assess predictors of undergoing surgery. Survival outcomes were compared using Kaplan-Meier and propensity score-adjusted and inverse probability of treatment-weighted Cox proportional hazards methods. Sensitivity analyses were performed to account for unmeasured confounders.Results: A total of 616 patients (64%) received LP-CRT, and 353 (36%) received TL. On multivariable logistic regression, patients with advanced nodal disease were less likely to receive TL (N2 vs N0, 26.6% vs 43.4%, odds ratio [OR] 0.52, 95% confidence interval [CI] 0.37-0.73; N3 vs N0, 19.1% vs 43.4%, OR 0.23, 95% CI 0.07-0.77), whereas patients treated in high case-volume facilities were more likely to receive TL (46.1% vs 31.5%, OR 1.78, 95% CI 1.27-2.48). Median survival for TL versus LP was 61 versus 39 months (P