Increase in primary surgical treatment of T1 and T2 oropharyngeal squamous cell carcinoma and rates of adverse pathologic features: National Cancer Data Base.
Increase in primary surgical treatment of T1 and T2 oropharyngeal squamous cell carcinoma and rates of adverse pathologic features: National Cancer Data Base.
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DOI：
10.1002/cncr.29938
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发表时间：
2016-05-15
期刊：
影响因子：
6.2
通讯作者：
Roman BR
中科院分区：
文献类型：
--
作者：
Cracchiolo JR;Baxi SS;Morris LG;Ganly I;Patel SG;Cohen MA;Roman BR
对于早期T分类（T1-T2）口咽鳞状细胞癌（OPSCC）患者的初次手术治疗越来越感兴趣，其既定目标是降低或避免辅助治疗。我们试图确定这种兴趣在多大程度上转化为实践模式的变化，以及术后不良病理特征的发生率。2004 - 2013年国家癌症数据库（NCDB）中接受治疗的T1-T2 OPSCC患者被分类为接受原发性手术或原发性放射治疗。研究了治疗选择的趋势和与初次手术选择相关的因素。分析了不良病理特征的发生率，包括切缘阳性、囊外扩散（ECS）以及手术后的晚期T和N分期。在8，768例T1-T2 OPSCC患者中，68%接受了初次手术治疗，从2004年的56%增加到2013年的82%（p <0.0001）。最高和最低容量的医院分别治疗了78%和59%的初次手术患者（O.R. 2.23 C.I. 1.55 - 3.22，p <0.0001）。较高的淋巴结分期预示着较低的初次手术率，但大多数临床N2/N3疾病患者接受了初次手术。在手术患者中，24%的切缘阳性，25%的ECS阳性。阳性边缘随时间减少（p <0.0001），在高容量中心较少见（p <0.0001）。在单一模式治疗的候选者中（临床T1-T2/N0-N1），33%具有阳性切缘和/或ECS，47%具有至少一种不良特征（T3-T4、N2-N3、阳性切缘和/或ECS）。早期T期OPSCC的主要手术治疗已变得越来越普遍。
There has been increasing interest in primary surgical treatment of patients with early T classification (T1–T2) oropharyngeal squamous cell carcinoma (OPSCC), with the stated goal of de-escalating or avoiding adjuvant treatment. We sought to determine the degree to which this interest has translated into changes in practice patterns, and the rates of adverse post-operative pathologic features. Patients with T1–T2 OPSCC in the National Cancer Database (NCDB) treated from 2004–2013 were categorized as receiving primary surgical or primary radiation-based treatment. Trends in treatment selection and factors related to selection of primary surgery were examined. The rates of adverse pathologic features including positive margins, extracapsular spread (ECS), and advanced T and N stage following surgery were analyzed. Of 8,768 patients with T1–T2 OPSCC, 68% received primary surgical treatment, increasing from 56% in 2004 to 82% in 2013 (p<0.0001). The highest versus lowest volume hospitals treated 78% versus 59% of patients with primary surgery (O.R. 2.23 C.I. 1.55–3.22, p<0.0001). Higher nodal stage predicted lower rates of primary surgery, but the majority of patients with clinical N2/N3 disease underwent primary surgery. Among surgical patients, positive margins were present in 24% and ECS in 25%. Positive margins decreased over time (p<0.0001) and were seen less often at high volume centers (p<0.0001). Among candidates for single modality therapy (clinical T1–T2/N0–N1), 33% had positive margins and/or ECS, and 47% had at least one adverse feature (T3–T4, N2–N3, positive margins, and/or ECS). Primary surgical treatment for early T-stage OPSCC has become more widespread.