Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma
Comorbid predictors of poor response to chemoradiotherapy for laryngeal squamous cell carcinoma
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DOI：
10.1002/lary.22489
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发表时间：
2012-03-01
期刊：
影响因子：
2.6
通讯作者：
Nathan, Cherie-Ann O.
中科院分区：
文献类型：
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作者：
Hu, Melissa;Ampil, Fred;Nathan, Cherie-Ann O.
目的/假设：探讨喉鳞癌初次治疗后医学合并症与疾病控制之间是否存在相关性。研究设计：回顾性医疗记录回顾。方法：对我院1997 ~ 2011年诊断为喉癌的患者进行回顾性分析。采用成人共病评价27 （ACE 27）指数评价共病健康的严重程度。计算十年无病生存率和中位无病间隔，并使用log-rank检验确定疾病复发与合并症因素之间的显著相关性。采用Cox比例风险回归模型确定疾病复发的独立显著危险因素。结果：在确定的181例患者中，121例接受了非手术治疗，包括初级放疗（XRT）（49%）或放化疗（CRT）（51%）。60例患者（50%）出现疾病复发。10年无病生存率为23.8%，中位无病生存期为58个月（95%可信区间为12-108个月）。与治疗后10年内复发显著相关的因素有肾脏疾病（P < 0.01）、肺部疾病（P < 0.01）、营养不良（P < 0.01）、T大小（P < 0.01）、分期（P = 0.02）、ACE 27指数（P < 0.01）。复发的独立显著危险因素为营养不良（P < 0.01）、T分期（P = 0.01）和ACE 27 （P < 0.01）。T期校正风险比为1.43，ACE 27为2.58，营养不良为2.15。结论：本研究结果表明，XRT/CRT治疗喉癌的合并症增加与疾病复发之间存在显著关联。在初步治疗计划中考虑合并症的健康状况可以提高喉鳞癌患者的成功率和生存率。
Objectives/Hypothesis: To investigate whether a correlation exists between medical comorbidities and disease control following primary therapy of laryngeal squamous cell carcinoma.Study Design: Retrospective medical record review.Methods: A retrospective chart review was performed on patients diagnosed with laryngeal carcinoma between 1997 and 2011. The Adult Comorbidity Evaluation 27 (ACE 27) index was used to evaluate severity of comorbid health. Ten-year disease-free survival rates and median disease-free intervals were calculated, and significant associations between disease recurrence and comorbid factors were determined using the log-rank test. Independent significant risk factors for disease recurrence were determined with the Cox proportional hazard regression model.Results: Of the 181 patients identified, 121 were treated nonsurgically with either primary radiotherapy (XRT) (49%) or chemoradiotherapy (CRT) (51%). Sixty patients (50%) experienced recurrence of their disease. The 10-year disease-free survival rate was 23.8%, and the median disease-free survival was 58 months (95% confidence interval, 12-108 months). Factors observed to be significantly associated with recurrence within 10 years after treatment were renal disease (P < .01), pulmonary disease (P < .01), malnutrition (P < .01), T size (P < .01), stage (p = .02), and ACE 27 Index (P < .01). Independent significant risk factors for recurrence were malnutrition (P < .01), T stage (p = .01), and ACE 27 (P < .01). Adjusted hazard ratios were 1.43 for T stage, 2.58 for ACE 27, and 2.15 for malnutrition.Conclusions: The results of this study demonstrate that there is a significant association between increased comorbidity and recurrent disease in laryngeal carcinoma treated with XRT/CRT. The consideration of comorbid health in primary treatment planning may improve the success and survival of patients with laryngeal squamous cell carcinoma.