Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer
Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer
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DOI：
10.1002/cncr.32292
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发表时间：
2019-10-01
期刊：
影响因子：
6.2
通讯作者：
Minh Tam Truong
中科院分区：
文献类型：
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作者：
Patel, Sagar A.;Qureshi, Muhammad M.;Minh Tam Truong
喉癌患者5年总生存率（OS）的下降与III/IV期疾病非手术治疗的增加有关。为了进一步评估这一假设，作者评价了根据肿瘤和淋巴结负荷分层的保留喉方法（CRT）或部分喉切除术（PL）和全喉切除术（TL）之间的近期OS趋势和使用模式。方法使用美国国家癌症数据库确定2003年至2011年期间接受CRT或前期PL或TL治疗的8703例III/IV期（不包括T1肿瘤）喉鳞状细胞癌患者，伴或不伴辅助治疗。使用Kaplan-Meier方法和考克斯比例风险模型分析OS。结果在非T4、低淋巴结负荷（T2 N1或T3 N 0-N1）疾病患者中，CRT、PL和TL之间的生存率无差异。与接受CRT的患者相比，患有非T4、高淋巴结负荷（T2-T3 N2-N3）疾病的患者在接受或不接受辅助治疗的情况下接受TL的死亡风险更高（风险比，1.25; 95%CI，1.04-1.51; P = 0.016）。对于T4 N 0-N3肿瘤，与CRT相比，TL与OS改善相关（风险比，0.80; 95% CI，0.62-0.92; P = .002）。CRT和PL在所有阶段组的结局无统计学显著差异。自2006年以来，CRT的使用有所下降，T4疾病的TL治疗有所增加，而PL率保持稳定的低水平。结论对于非T4低淋巴结负荷的喉癌患者，手术和非手术方法之间的生存率没有差异。非T4、高淋巴结负荷疾病患者可能从确定性CRT中获益。全喉切除术在T4疾病患者中仍然是有利的。
Background The declining 5-year overall survival (OS) of patients with laryngeal cancer has been associated with increased nonsurgical management of stage III/IV disease. To further assess this hypothesis, the authors evaluated recent OS trends and patterns of use between larynx-preserving approaches with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy (TL) stratified by tumor and nodal burden. Methods The National Cancer Data Base was used to identify 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated between 2003 and 2011 with CRT or upfront PL or TL with or without adjuvant therapy. OS was analyzed using the Kaplan-Meier method and a Cox proportional hazards model. Results Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL. Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT (hazard ratio, 1.25; 95% CI, 1.04-1.51; P = .016). For T4N0-N3 tumors, TL compared with CRT was associated with improved OS (hazard ratio, 0.80; 95% CI, 0.62-0.92; P = .002). No statistically significant difference in outcome was noted between CRT and PL for all stage groups. The use of CRT has declined and receipt of TL has increased since 2006 for T4 disease, whereas PL rates have remained stably low. Conclusions No survival differences were noted between surgical and nonsurgical approaches for patients with non-T4, low nodal burden laryngeal cancer. Patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease.