Effect of Postoperative Radiotherapy on Survival for Surgically Managed pT3N0 and pT4aN0 Laryngeal Cancer: Analysis of the National Cancer Data Base
Effect of Postoperative Radiotherapy on Survival for Surgically Managed pT3N0 and pT4aN0 Laryngeal Cancer: Analysis of the National Cancer Data Base
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DOI：
10.1002/cncr.30586
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发表时间：
2017-06-15
期刊：
影响因子：
6.2
通讯作者：
Day, Terry A.
中科院分区：
文献类型：
--
作者：
Graboyes, Evan M.;Zhan, Kevin Y.;Day, Terry A.
背景技术背景：本研究旨在确定术后放疗（PORT）对手术治疗的pT 3-T4 aN 0喉鳞状细胞癌（SCC）患者总生存率的影响。方法：对2004年至2013年的国家癌症数据库进行了审查。手术治疗的pT 3 - 4aN 0喉鳞状细胞癌患者手术切缘阴性。单变量和多变量考克斯回归分析用于确定与生存相关的因素。结果：共纳入1460例患者，其中46.2%患有pT 3 N 0疾病（674例患者），53.8%患有pT 4aN 0疾病（786例患者）。约72.0%的pT 3 N 0疾病患者（485例患者）和50.1%的pT 4aN 0疾病患者（394例患者）接受了PORT。在单变量分析中，没有发现PORT与pT 3 N 0疾病患者的总生存期改善相关（风险比[HR]，0.84; 95%置信区间[95% CI]，0.62-1.14），但与pT 4aN 0疾病患者相关（HR，0.57; 95% CI，0.45-0.71）。对于pT 3 N 0喉鳞状细胞癌患者，在一项多变量考克斯回归分析中，调整了年龄>65岁、合并症严重程度、喉亚部位、喉切除范围和淋巴结切除数量，没有发现PORT与生存率改善相关（调整后HR，0.88; 95% CI，0.64-1.21）。对于pT 4aN 0疾病患者，PORT给药与多变量分析中生存率的改善相关，调整了年龄>65岁、合并症严重程度、喉亚部位、淋巴结切除数量和医院类型（调整后HR，0.58; 95%CI，0.46-0.73）。结论：对于手术治疗的pT 3 N 0喉鳞状细胞癌伴阴性切缘的患者，PORT似乎与生存率的提高无关。尽管有生存益处，但近50%的pT 4aN 0喉SCC和阴性手术切缘患者没有接受标准护理PORT。(C)2017美国癌症协会
BACKGROUND: The current study was conducted to determine the effect of postoperative radiotherapy (PORT) on overall survival in patients with surgically managed pT3-T4aN0 laryngeal squamous cell carcinoma (SCC). METHODS: A review of the National Cancer Data Base from 2004 through 2013 was performed. Patients with surgically managed pT3-4aN0 laryngeal SCC with negative surgical margins were included. Univariable and multivariable Cox regression analyses were used to determine factors associated with survival. RESULTS: A total of 1460 patients were included, 46.2% of whom had pT3N0 disease (674 patients) and 53.8% of whom had pT4aN0 disease (786 patients). Approximately 72.0% of the patients with pT3N0 disease (485 patients) and 50.1% of the patients with pT4aN0 disease (394 patients) received PORT. PORT was not found to be associated with improved overall survival on univariable analysis for patients with pT3N0 disease (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.62-1.14), but was for patients with pT4aN0 disease (HR, 0.57; 95% CI, 0.45-0.71). For patients with pT3N0 SCC of the larynx, in a multivariable Cox regression analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, extent of laryngectomy, and number of lymph nodes removed, PORT was not found to be associated with improved survival (adjusted HR, 0.88; 95% CI, 0.64-1.21). For patients with pT4aN0 disease, the administration of PORT was associated with improved survival on multivariable analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, number of lymph nodes removed, and type of hospital (adjusted HR, 0.58; 95% CI, 0.46-0.73). CONCLUSIONS: For patients with surgically managed pT3N0 laryngeal SCC with negative margins, PORT does not appear to be associated with improved survival. Despite a survival benefit, nearly 50% of patients with pT4aN0 laryngeal SCC and negative surgical margins do not receive standard-of-care PORT. (C) 2017 American Cancer Society.