Patterns of care and outcomes of adjuvant therapy for high-risk head and neck cancer after surgery
Patterns of care and outcomes of adjuvant therapy for high-risk head and neck cancer after surgery
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DOI：
10.1002/hed.25103
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发表时间：
2018-06-01
影响因子：
2.9
通讯作者：
Schreiber, David
中科院分区：
文献类型：
--
作者：
Osborn, Virginia Wedell;Givi, Babak;Schreiber, David
背景术后放化疗（CRT）被认为是局部晚期头颈部癌患者的标准治疗，患者切缘阳性和/或囊外浸润（ECE）。方法查询国家癌症数据库（NCDB），以确定患有头颈部鳞状细胞癌的患者，III期至IVB期疾病或切缘阳性和/或囊外浸润（ECE）。或2004年至2012年期间诊断为ECE并接受术后放疗（RT）的患者。使用单变量和多变量logistic和考克斯回归，我们评估了CRT使用的预测因子和影响总生存率（OS）的协变量，包括在一个倾向匹配的subset.ResultsOf 12224例患者，67.1%的阳性边缘和/或ECE接受CRT，以及54.0%没有阳性边缘和/或ECE。单纯RT的5年OS为61.6%，CRT为67.4%。在倾向匹配的队列中，OS效益持续CRT，包括在一个子集与积极的利润率和/或ECE，但不是没有.ConclusionPostoperative CRT似乎未充分利用积极的利润率和/或ECE和过度利用没有积极的利润率和/或ECE。CRT与OS改善相关，但仅在边缘和/或ECE阳性的亚组中获益持续。
BackgroundPostoperative chemoradiotherapy (CRT) is considered standard of care in patients with locally advanced head and neck cancer with positive margins and/or extracapsular extension (ECE).MethodsThe National Cancer Data Base (NCDB) was queried to identify patients with squamous cell carcinoma of the head and neck with stages III to IVB disease or with positive margins and/or ECE diagnosed between 2004 and 2012 receiving postoperative radiotherapy (RT). Using univariable and multivariable logistic and Cox regression, we assessed for predictors of CRT use and covariables impacting overall survival (OS), including in a propensity-matched subset.ResultsOf 12224 patients, 67.1% with positive margins and/or ECE received CRT as well as 54.0% without positive margins and/or ECE. The 5-year OS was 61.6% for RT alone versus 67.4% for CRT. In the propensity-matched cohort, OS benefit persisted with CRT, including in a subset with positive margins and/or ECE but not without.ConclusionPostoperative CRT seems underutilized with positive margins and/or ECE and overutilized without positive margins and/or ECE. The CRT was associated with improved OS but the benefit persisted only in the subset with positive margins and/or ECE.