目的:评估术后放疗(PORT)是否可以改善pT4aN0上颌牙龈或硬腭鳞状细胞癌(SCC)上颌骨切除术患者的肿瘤大小。
方法:回顾性分析。
方法:2004年至2019年国家癌症数据库。
方法:包括接受上颌骨切除术的成年患者(部分,小计,或全部)和颈淋巴结清扫术,用于上颌牙龈或硬腭的初治边缘阴性pT4aN0SCC。根据年龄调整,性别,种族,保险状况,收入,教育,城市/农村,设施类型,区域,合并症指数,肿瘤分级,和肿瘤扩展。将逆概率权重纳入多变量Cox比例风险模型。根据肿瘤大小进行先验事后亚组分析。
结果:我们纳入了416例因上颌牙龈或硬腭pT4aN0SCC而接受上颌切除术的患者(平均[标准差]年龄,71.5[11.3]岁;男性,190[45.7%];肿瘤大小2厘米,362[87%])。总的来说,49.3%的患者接受PORT(205例患者)。与单纯手术相比,PORT的生存率提高了50%(调整后的风险比[aHR],0.50;95%置信区间[95%CI],0.32-0.81)。关于子群分析,PORT与肿瘤2cm的生存率提高相关(aHR,0.47;95%CI,0.29-0.77),但不适用于<2cm的肿瘤(aHR,1.15;95%CI,0.33-4.08)。
结论:绝大多数pT4aN0骨侵入性上颌牙龈和硬腭SCC患者受益于PORT。肿瘤<2厘米的患者没有从辅助治疗中获益,这表明仅骨侵入可能不足以成为治疗升级的标准。
OBJECTIVE: To evaluate whether postoperative radiotherapy (PORT) improves survival among patients who received maxillectomy for pT4aN0 maxillary gingival or hard palate squamous cell carcinoma (SCC) with respect to tumor size.
METHODS: Retrospective analysis.
METHODS: National Cancer Database from 2004 to 2019.
METHODS: Included adult patients who received maxillectomy (partial, subtotal, or total) and neck dissection for treatment-naive margin negative pT4aN0 SCC of the maxillary gingiva or hard palate. Adjusted for age, gender, race, insurance status, income, education, urban/rural, facility type, region, comorbidity index, tumor grade, and tumor extension. Inverse probability weights were incorporated into a multivariable Cox proportional hazards model. A priori post hoc subgroup analysis was performed according to tumor size.
RESULTS: We included 416 patients who underwent maxillectomy for pT4aN0 SCC of the maxillary gingiva or hard palate (mean [standard deviation] age, 71.5 [11.3] years; male, 190 [45.7%]; tumor size 2 cm, 362 [87%]). Overall, 49.3% of patients received PORT (205 patients). PORT was associated with a 50% improvement in survival compared to surgery alone (adjusted hazard ratio [aHR], 0.50; 95% confidence interval [95% CI], 0.32-0.81). On subgroup analysis, PORT was associated with improved survival for tumors 2 cm (aHR, 0.47; 95% CI, 0.29-0.77), but not for tumors < 2 cm (aHR, 1.15; 95% CI, 0.33-4.08).
CONCLUSIONS: The vast majority of patients with pT4aN0 bone-invading SCC of the maxillary gingiva and hard palate benefit from PORT. Patients with tumors < 2 cm did not demonstrate a survival benefit from adjuvant treatment, suggesting that bony invasion alone may not be sufficient criteria for treatment escalation.