Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients
Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients
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DOI：
10.1245/s10434-016-5629-x
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发表时间：
2017-03-01
影响因子：
3.7
通讯作者：
Yen, Tzu-Chen
中科院分区：
文献类型：
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作者：
Liao, Chun-Ta;Wen, Yu-Wen;Yen, Tzu-Chen
国家综合癌症网络指南建议口腔鳞状细胞癌（OSCC）和cT4b疾病患者应纳入临床试验或采用非手术方法治疗。然而，在有足够安全裕度的患者中，手术可能是可行的。利用台湾癌症登记数据库，我们研究了cT4b OSCC患者的预后与治疗方法的关系。在2004年至2010年间发现的18910例未经治疗的原发性OSCC患者中，492例（2.6%）患有cT4b肿瘤。其中，327例（66%）接受手术初始治疗，165例（34%）接受非手术初始治疗。在后一组中，78名患者随后接受了手术。5年疾病特异性生存率(DSS) >= 45%被认为是有利的结果。最初接受手术治疗的cT4b患者观察到更好的5年DSS和总生存率（OS）（与非手术相比；DSS分别为51%和38%；OS分别为43%和27%，p < 0.001）。在最初接受手术治疗的参与者中，cN0-2疾病患者的5年生存率（DSS: cN0, 59%; cN1, 53%; cN2, 46%; OS: cN0, 49%; cN1, 50%; cN2, 37%）优于cN3疾病患者（DSS: 0%; OS: 0%）。在最初接受非手术治疗的cT4b患者中，随后接受手术治疗的受试者表现出更好的结果。大约三分之二的cT4b OSCC患者进行了原发性手术，cN0-2病例预后良好。最初接受非手术方法的患者随后可以接受手术治疗并获得良好的结果。
The National Comprehensive Cancer Network guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a nonsurgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach.Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6 %) had cT4b tumors. Of them, 327 (66 %) received initial treatment with surgery, whereas 165 (34 %) were initially treated with a nonsurgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) >= 45 % was considered as a favorable outcome.Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (vs. nonsurgery; DSS, 51 vs. 38 %; OS, 43 vs. 27 %, respectively, p < 0.001). Of the participants initially treated with surgery, patients with cN0-2 disease had better 5-year survival rates (DSS: cN0, 59 %; cN1, 53 %; cN2, 46 %; OS: cN0, 49 %; cN1, 50 %; cN2, 37 %) than those with cN3 disease (DSS: 0 %; OS: 0 %). Among cT4b patients who initially received a nonsurgical treatment, subjects who subsequently underwent surgery showed better outcomes.Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0-2 cases showing a good prognosis. Patients who initially received a nonsurgical approach can subsequently be treated with surgery and achieve favorable outcomes.