Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate-risk features.
Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate-risk features.
复制标题
辅助放化疗对具有中等风险特征的口咽癌的护理模式和生存影响。
DOI：
10.1002/hed.25808
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
StJohn,MaieA
中科院分区：
文献类型：
--
作者：
Goel,AlexanderN;Sangar,Sophia;Mukdad,Laith;Heaton,ChaseM;Ryan,WilliamR;Wang,MarileneB;Long,JenniferL;StJohn,MaieA
在具有中等风险特征的口咽鳞状细胞癌（OPSCC）患者中，比较了辅助放化疗（aCRT）和辅助放疗（aRT）的生存结局。方法我们在国家癌症数据库中确定了2164例OPSCC患者，这些患者没有阳性切缘或囊外扩展，并且至少具有一个中等风险功能：pT 3 ‐T4疾病、≥ 2个阳性淋巴结、IV/V级淋巴结疾病和/或淋巴血管浸润。我们评估了aCRT使用的预测因素和影响总生存率的协变量。ResultsaCRT常用于人乳头瘤病毒（HPV）阳性（62.0%）和HPV阴性（64.3%）的OPSCC患者。较高的N分期、IV/V级颈部疾病和较年轻的年龄强烈预测aCRT的使用。在HPV阳性患者中，aCRT与aRT相比无显著的生存获益（风险比[HR]，0.93; 95%置信区间[CI]，0.62 - 1.38;P= .71）或HPV阴性（HR，0.75; 95% CI，0.51 - 1.10;结论：尽管aCRT的使用率很高，但对于具有中等风险特征的OPSCC（包括HPV阴性肿瘤），aCRT与aRT相比生存率并不相关。
BackgroundSurvival outcomes for adjuvant chemoradiotherapy (aCRT) and adjuvant radiotherapy (aRT) were compared in patients with oropharyngeal squamous cell carcinoma (OPSCC) with intermediate‐risk features.MethodsWe identified 2164 patients with OPSCC in the National Cancer Database without positive margins or extracapsular extension and with at least one intermediate‐risk feature: pT3‐T4 disease, ≥two positive lymph nodes, level IV/V nodal disease, and/or lymphovascular invasion. We assessed predictors of aCRT use and covariables impacting overall survival.ResultsaCRT was commonly used for both human papillomavirus (HPV)‐positive (62.0%) and HPV‐negative (64.3%) patients with OPSCC. Higher N stage, level IV/V neck disease, and younger age strongly predicted aCRT utilization. There was no significant survival benefit associated with aCRT vs aRT in HPV‐positive (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.62‐1.38;P= .71) or HPV‐negative (HR, 0.75; 95% CI, 0.51‐1.10;P= .15) disease.ConclusionsDespite high rates of utilization, aCRT is not associated with better survival vs aRT for OPSCC with intermediate‐risk features, including HPV‐negative tumors.