Impact of Previous Tracheotomy as a Prognostic Factor in Patients with Locally Advanced Squamous Cell Carcinoma of the Larynx Submitted to Concomitant Chemotherapy and Radiation
Impact of Previous Tracheotomy as a Prognostic Factor in Patients with Locally Advanced Squamous Cell Carcinoma of the Larynx Submitted to Concomitant Chemotherapy and Radiation
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DOI：
10.1159/000163034
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发表时间：
2008-01-01
期刊：
影响因子：
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通讯作者：
Kligerman, Jacob
中科院分区：
文献类型：
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作者：
Herchenhorn, Daniel;Dias, Fernando L.;Kligerman, Jacob
假设：化疗和放疗的结合是局部晚期喉癌的标准非手术治疗。然而，没有有效的标志物来预测非手术治疗的结果。既往气管切开术对接受同步放化疗患者的影响尚不清楚。研究设计：非随机前瞻性研究。采用考克斯比例风险模型分析预后因素，如分期、年龄、体力状态、化疗周期数、放疗剂量、VIb期疾病和既往气管切开术。Kaplan-Meier和log rank检验用于评估无进展生存期和总生存期。患者和方法：前瞻性选择III/IV期喉癌患者。治疗包括顺铂100 mg/m2，每3周1次，共3个周期，放疗总剂量70.2戈伊和挽救性手术。结果：49例患者进行了分析，12例（24.5%）患者在治疗前进行了气管切开术。有气管切开史的患者完全缓解率较低（41.7 vs. 75%，p = 0.034，HR 0.55，CI 95% 0.27-1.11），无进展生存期较短（HR 2.83，CI 95% 1.60-4.88，p < 0.001）和中位总生存期（12 vs. 56个月，HR 2.37，CI 95% 1.43-3.93，p < 0.001）。此外，观察到3年生存率存在显著差异（6 vs. 61%，p = 0.001），有利于未行气管切开术的组。有趣的是，当用其他预后因素调整时，既往气管切开术的影响并没有改变（HR 8.7，CI 95% 3.1-24.0，p < 0.001）。结论：既往气管切开术是接受化疗联合放疗患者的一个不良预后因素，在选择患者进行更积极的治疗策略时，应将其视为一个不良临床预后因素。版权所有（C）2008 S. Karger AG，巴塞尔
Hypothesis: The combination of chemotherapy and radiotherapy is a standard nonsurgical treatment for locally advanced laryngeal cancer. Nevertheless, there are no validated markers to predict the outcome of nonsurgical therapies. The impact of previous tracheotomy is not clear in patients submitted to concomitant chemoradiotherapy. Study Design: A non-randomized prospective study. Prognostic factors such as stage, age, performance status, number of chemotherapy cycles, radiotherapy dose, stage VIb disease, and previous tracheotomy were analyzed using the Cox's proportional hazard model. The Kaplan-Meier and log rank tests were used to evaluate the progression-free and overall survival. Patients and Methods: Patients with stage III/IV laryngeal carcinoma were prospectively selected. Treatment consisted of cisplatin 100 mg/m(2) every 3 weeks for 3 cycles, radiotherapy to a total dose of 70.2 Gy and salvage surgery. Results: Forty-nine patients were analyzed; tracheotomy was performed in 12 patients (24.5%) before therapy. Patients who had previous tracheotomy had a lower rate of complete response (41.7 vs. 75%, p = 0.034, HR 0.55, CI 95% 0.27-1.11), shorter progression free-survival (HR 2.83, CI 95% 1.60-4.88, p < 0.001), and median overall survival (12 vs. 56 months, HR 2.37, CI 95% 1.43-3.93, p < 0.001), in comparison to those without a tracheotomy. Moreover a significant difference was observed in 3-year survival rates (6 vs. 61%, p = 0.001), in favor of the group without tracheotomy. Interestingly, the impact of previous tracheotomy was not altered when adjusted by other prognostic factors (HR 8.7, CI 95% 3.1-24.0, p < 0.001). Conclusions: Previous tracheotomy is a negative prognostic factor for patients submitted to chemotherapy combined with radiotherapy and should be considered as a negative clinical prognostic factor in the selection of patients for more aggressive treatment strategies. Copyright (C) 2008 S. Karger AG, Basel