Curative-Intent Aggressive Treatment Improves Survival in Elderly Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma and High Comorbidity Index.
Curative-Intent Aggressive Treatment Improves Survival in Elderly Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma and High Comorbidity Index.
复制标题
DOI：
10.1097/md.0000000000003268
复制
发表时间：
2016-04
期刊：
影响因子：
1.6
通讯作者：
Wu SY
中科院分区：
文献类型：
--
作者：
Chen JH;Yen YC;Yang HC;Liu SH;Yuan SP;Wu LL;Lee FP;Lin KC;Lai MT;Wu CC;Chen TM;Chang CL;Chow JM;Ding YF;Wu SY
补充数字内容可在文本中找到。 对于局部晚期头颈鳞状细胞癌 (HNSCC)，治疗决策取决于合并症或年龄。我们评估了具有不同查尔森合并症指数（CCI）评分和年龄的患者的治疗结果，以确定积极治疗是否可以提高生存率。我们分析了台湾国民健康保险和癌症登记数据库的数据，纳入了美国癌症联合委员会 (AJCC) III 期或 IV 期 HNSCC（国际疾病分类，第九版，临床修改代码 140.0–148.9）的 20 岁以上患者，正在接受手术、化疗 (CT)、放疗 (RT)、同步放化疗 (CCRT)、序贯 CT 和 RT 或手术辅助治疗。排除标准为既往癌症史、远处转移、AJCC I 或 II 期、性别数据缺失、年龄 < 20 岁、鼻咽癌、原位癌、肉瘤和 HNSCC 复发。索引日期是首次诊断 HNSCC 的日期，并使用 CCI 对合并症进行评分。入组患者被分为第一组（积极治疗）和第二组（最佳支持治疗或姑息治疗）。我们招募了 21,174 名无远处转移的 III 期或 IV 期 HNSCC 患者（中位随访时间为 3.25 年）。第 1 组和第 2 组分别有 18,584 名患者和 2232 名患者。调整年龄、性别和临床分期后，第1组总体死亡的调整后风险比（95%置信区间）为0.33（0.31-0.35）、0.34（0.31-0.36）和0.37（0.28-0.49），接受根治性手术积极治疗的患者全因死亡风险比为1.13（0.82-1.55）。对于 CCI 分数 ≥10、5 至 9 和 <5，分别为 0.67 (0.62–0.73) 和 0.49 (0.46–0.53)。积极的治疗可提高老年（≥65 岁）和危重 HNSCC 患者的生存率。治愈性非手术积极治疗（包括确定性 RT 或 CCRT）可能适合 CCI 评分≥10 的 HNSCC 患者。
Supplemental Digital Content is available in the text For locally advanced head and neck squamous cell carcinoma (HNSCC), therapeutic decisions depend on comorbidity or age. We estimated the treatment outcomes of patients with different Charlson comorbidity index (CCI) scores and ages to determine whether aggressive treatment improves survival. Data from the Taiwan National Health Insurance and cancer registry databases were analyzed, and we included >20-year-old patients with American Joint Committee on Cancer (AJCC) stage III or IV HNSCC (International Classification of Diseases, Ninth Revision, Clinical Modification codes 140.0–148.9) undergoing surgery, chemotherapy (CT), radiotherapy (RT), concurrent chemoradiotherapy (CCRT), sequential CT and RT, or surgery with adjuvant treatment. The exclusion criteria were a past cancer history, distant metastasis, AJCC stage I or II, missing sex data, an age < 20 years, nasopharyngeal cancer, in situ carcinoma, sarcoma, and HNSCC recurrence. The index date was the date of first HNSCC diagnosis, and comorbidities were scored using the CCI. The enrolled patients were categorized into Group 1 (curative-intent aggressive treatments) and Group 2 (best supportive care or palliative treatments). We enrolled 21,174 stage III or IV HNSCC patients without distant metastasis (median follow-up, 3.25 years). Groups 1 and 2 comprised 18,584 and 2232 patients, respectively. After adjustment for age, sex, and clinical stage, adjusted hazard ratios (95% confidence intervals) of overall death in Group 1 were 0.33 (0.31–0.35), 0.34 (0.31–0.36), and 0.37 (0.28–0.49), and those of all-cause death among patients undergoing curative surgical aggressive treatments were 1.13 (0.82–1.55), 0.67 (0.62–0.73), and 0.49 (0.46–0.53) for CCI scores of ≥10, 5 to 9, and <5, respectively. Aggressive treatments improve survival in elderly (≥65 years) and critically ill HNSCC patients. Curative nonsurgical aggressive treatments including definitive RT or CCRT might be suitable for HNSCC patients with CCI scores ≥10.