National treatment trends in human papillomavirus-positive oropharyngeal squamous cell carcinoma
National treatment trends in human papillomavirus-positive oropharyngeal squamous cell carcinoma
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DOI：
10.1002/cncr.32654
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发表时间：
2019-12-11
期刊：
影响因子：
6.2
通讯作者：
Eskander, Antoine
中科院分区：
文献类型：
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作者：
Zhan, Kevin Y.;Puram, Sidharth, V;Eskander, Antoine
人类乳头瘤病毒（HPV）介导的口咽癌（OPC）与HPV阴性的OPC相比，生存率显著提高，可以通过手术和非手术方法成功治疗。OPC的国家治疗趋势与国家癌症数据库（NCDB）进行了调查。方法对2010-2014年全国疾病分类数据库中HPV介导的原发性OPC进行回顾性分析。多变量回归分析用于确定非手术治疗和接受辅助放化疗（CRT）的预测因素。结果有13，363名患者被确定，诊断时的中位年龄为58岁。三联治疗（手术+辅助化疗）的发生率从2010年的23.7%下降到2014年的16.9%（R-2 = 0.96），而非手术治疗的发生率从63.9%上升到68.7%（R-2 = 0.89）。治疗量最高四分位数的医院（Q1; n = 29）的阳性边缘率（16.3%）低于最低四分位数的中心（n = 741;阳性边缘率，36.4%; P <0.001）; Q1医院使用手术治疗明显更多。非手术治疗的独立预测因素包括年龄较大、疾病晚期、住院量较低、居住在离医院较近或美国太平洋地区以外的地区。在手术治疗的患者中，年龄较小、住院量较低、淋巴结疾病、手术切缘阳性和淋巴结延伸（ENE）也预示着更多的辅助CRT使用。结论2010年至2014年，前期手术治疗的使用有所减少。医院容量与手术切缘阳性率呈强负相关。前期治疗策略不仅可以通过分期预测，还可以通过患者、地理和医院特定因素预测。在对切缘阳性、ENE和病理分期进行调整后，较低的住院量仍然与增加的三联疗法独立相关。
Background Human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC) is associated with dramatically improved survival in comparison with HPV-negative OPC and can be successfully treated with surgical and nonsurgical approaches. National treatment trends for OPC were investigated with the National Cancer Data Base (NCDB). Methods The NCDB was reviewed for primary HPV-mediated OPC in 2010-2014. Multivariable regression was used to identify predictors of both nonsurgical therapy and receipt of adjuvant chemoradiation (CRT). Results There were 13,363 patients identified with a median age at diagnosis of 58 years. The incidence of triple-modality treatment (surgery with adjuvant chemotherapy) decreased from 23.7% in 2010 to 16.9% in 2014 (R-2 = 0.96), whereas the incidence of nonsurgical treatment increased from 63.9% to 68.7% (R-2 = 0.89). Hospitals in the top treatment volume quartile (quartile 1 [Q1]; n = 29) had a lower rate of positive margins (16.3%) than bottom-quartile centers (n = 741; rate of positive margins, 36.4%; P < .001); Q1 hospitals used surgical therapy significantly more. Independent predictors of nonsurgical therapy included older age, advanced disease, lower hospital volume, and living closer to the hospital or outside the Pacific United States. In surgically treated patients, younger age, lower hospital volume, nodal disease, positive surgical margins, and extranodal extension (ENE) also predicted more adjuvant CRT use. Conclusions The use of upfront surgical treatment decreased from 2010 to 2014. Hospital volume shows a strong, inverse correlation with the rate of positive surgical margins. The upfront treatment strategy is predicted not only by staging but also by patient-, geographic-, and hospital-specific factors. Lower hospital volume remains independently associated with increased triple-modality therapy after adjustments for positive margins, ENE, and pathologic staging.