■无论大小如何,具有下颌侵袭的口腔鳞状细胞癌(SCC)肿瘤均升级为pT4a。即使是有骨性侵袭的小肿瘤,建议将其分类为pT1-2,用于接受术后放疗(PORT)的局部晚期治疗途径。
■在接受pT4aN0口腔SCC下颌骨切除术的患者中,根据肿瘤大小评估PORT与总生存期的关系。
■这是一项回顾性分析,使用2004年1月1日至2019年12月31日美国国家癌症数据库的数据。包括所有接受下颌骨切除术以治疗初治pT4aN0口腔SCC且手术切缘阴性的患者。数据分析于2023年1月进行,并于2023年7月完成。
■港口与没有港口。
■使用熵平衡来平衡治疗组之间的协变量矩。加权多变量Cox比例风险回归用于测量PORT与与肿瘤大小相关的总生存期的相关性。
■在3268例pT4aN0口腔SCC患者中(平均[SD]年龄,65.9[12.1]岁;2024年[61.9%]男性和1244年[38.1%]女性),1851年(56.6%)收到港口,1417年(43.4%)未收到港口。在多变量分析中,对年龄进行了调整,保险状况,Charlson合并症指数评分,肿瘤部位,肿瘤分级,肿瘤大小,和港口。研究结果表明,PORT与总体生存率的提高有关,并且这种相对生存优势随着肿瘤大小的增加而呈上升趋势。也就是说,肿瘤越大,与使用PORT相关的生存优势越大。对于1068例肿瘤大于4cm的患者,对PORT有利的校正风险比(aHR)为0.63(95%CI,0.48-0.82);对于1774例肿瘤大于2cm但小于或等于4cm的患者,aHR为0.76(95%CI,0.62-0.93);对于426例肿瘤小于2cm的患者,aHR为0.81(95%CI,0.57-1.15)。
■在对接受pT4aN0口腔SCC下颌骨切除术的患者进行的回顾性分析中,PORT与总生存率改善相关,随着肿瘤大小的增加,其益处相对改善。这些发现表明,在该患者人群的PORT给药指南中应考虑肿瘤大小。
Oral cavity squamous cell carcinoma (SCC) tumors with mandibular invasion are upstaged to pT4a regardless of their size. Even small tumors with boney invasion, which would otherwise be classified as pT1-2, are recommended for the locally advanced treatment pathway to receive administration of postoperative radiotherapy (PORT).
To evaluate the association of PORT with overall survival according to tumor size among patients who received mandibulectomy for pT4aN0 oral cavity SCC.
This was a retrospective analysis using data from the US National Cancer Database from January 1, 2004, through December 31, 2019. All patients who received mandibulectomy for treatment-naive pT4aN0 oral cavity SCC with negative surgical margins were included. Data analyses were performed in January 2023 and finalized in July 2023.
PORT vs no PORT.
Entropy balancing was used to balance covariate moments between treatment groups. Weighted multivariable Cox proportional hazards regression was used to measure the association of PORT with overall survival associated with tumor size.
Among 3268 patients with pT4aN0 oral cavity SCC (mean [SD] age, 65.9 [12.1] years; 2024 [61.9%] male and 1244 [38.1%] female), 1851 (56.6%) received PORT and 1417 (43.4%) did not receive PORT. On multivariable analysis was adjusted for age, insurance status, Charlson Comorbidity Index score, tumor site, tumor grade, tumor size, and PORT. Findings indicated that PORT was associated with improved overall survival and that this relative survival advantage trended upwards with increasing tumor size. That is, the larger the tumor, the greater the survival advantage associated with the use of PORT. For the 1068 patients with tumors greater than 4 cm, the adjusted hazard ratio (aHR) in favor of PORT was 0.63 (95% CI, 0.48-0.82); for the 1774 patients with tumors greater than 2 cm but less than or equal to 4 cm, the aHR was 0.76 (95% CI, 0.62-0.93); and for 426 patients with tumors less than 2 cm, the aHR was 0.81 (95% CI, 0.57-1.15).
In this retrospective analysis of patients who received mandibulectomy for pT4aN0 oral cavity SCC, PORT was associated with improved overall survival, the benefit of which improved relatively with increasing tumor size. These findings suggest that tumor size should be considered in guidelines for PORT administration in this patient population.