Adjuvant chemoradiation does not improve survival in elderly patients with high-risk resected head and neck cancer
Adjuvant chemoradiation does not improve survival in elderly patients with high-risk resected head and neck cancer
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DOI：
10.1002/lary.26798
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发表时间：
2018-04-01
期刊：
影响因子：
2.6
通讯作者：
Minh Tam Truong
中科院分区：
文献类型：
--
作者：
Giacalone, Nicholas J.;Qureshi, Muhammad M.;Minh Tam Truong
目的/假设随机试验已经证明，辅助放化疗（CRT）的总生存率（OS）优于单纯辅助放疗（RT），对切除的头颈部鳞状细胞癌（HNSCC）患者有不良病理特征（手术切缘阳性[SM+]和/或囊外扩散[ECE]）。研究设计回顾性数据库研究MethodsUsing the National Cancer Database，我们确定了1，686例切除HNSCC的老年患者（年龄70岁），SM+和/或ECE，在1998年至2011年期间接受辅助CRT（491例患者，29%）或单独辅助RT（1，195例患者，71%）。在倾向评分匹配（PSM）前后均使用Kaplan-Meier方法估计3年生存率。使用考克斯回归modeling.ResultsMedian随访时间分别为23.5和42.8个月，所有和存活的患者，95%的置信区间（CI）的原油和调整后的风险比（HR）计算。接受辅助CRT和单纯RT的患者的3年OS分别为50.7%和44.4%（P = 0.002）。在多变量分析中，辅助CRT相对于单独辅助RT的OS无显著改善（HR：0.88，95% CI：0.73-1.06）。类似地，PSM队列显示，接受辅助CRT与单独接受辅助RT的患者的3年OS无显著差异（分别为48.8%和50.9%; P = .839）。结论虽然在SM+或ECE的切除HNSCC患者的随机试验中，辅助RT中加入化疗已被证明是有效的，在对照试验环境外治疗的老年患者中，其疗效可能较低。喉镜，128：831-840，2018
Objectives/HypothesisRandomized trials have demonstrated that adjuvant chemoradiotherapy (CRT) confers an overall survival (OS) benefit over adjuvant radiation therapy (RT) alone in patients with resected head and neck squamous cell carcinoma (HNSCC) with adverse pathologic features (positive surgical margins [SM+] and/or extracapsular extension [ECE]). Whether this OS benefit exists in an elderly population remains unknown.Study DesignRetrospective database study.MethodsUsing the National Cancer Database, we identified 1,686 elderly patients (age 70 years) with resected HNSCC with SM+ and/or ECE, who received adjuvant CRT (491 patients, 29%) or adjuvant RT alone (1,195 patients, 71%) between 1998 and 2011. Three-year survival rates were estimated using the Kaplan-Meier method both before and after propensity score matching (PSM). Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling.ResultsMedian follow-up was 23.5 and 42.8 months for all and surviving patients, respectively. Three-year OS was 50.7% and 44.4% among patients receiving adjuvant CRT and RT alone, respectively (P = .002). On multivariate analysis, there was no significant improvement in OS with adjuvant CRT relative to adjuvant RT alone (HR: 0.88, 95% CI: 0.73-1.06). Similarly, a PSM cohort showed no significant difference in the 3-year OS for patients receiving adjuvant CRT versus adjuvant RT alone (48.8% and 50.9%, respectively; P = .839).ConclusionsAlthough the addition of chemotherapy to adjuvant RT has been proven effective in randomized trials of patients with resected HNSCC with SM+ or ECE, it may be less efficacious in an elderly patient population treated outside of a controlled trial setting.Level of Evidence2c. Laryngoscope, 128:831-840, 2018