目的:确定接受手术治疗的声门上鳞状细胞癌(SCCa)的选择性颈淋巴结清扫(END)患者的比例,评估患者之间的关联,肿瘤,和END的治疗因素,并评估颈部管理与总生存率(OS)之间的关联。
方法:回顾性研究。
方法:国家癌症数据库(NCDB)2019参与者用户档案。
方法:先前未治疗的患者,从NCDB查询接受喉部分切除术治疗的临床淋巴结阴性(cN0)声门上SCCa。没有已知颈部管理和接受全喉切除术的患者被排除在外。通过logistic回归分析评估与END相关的患者和肿瘤因素。单变量Cox比例风险分析用于检查患者因素与OS之间的关联,多变量分析包括P<0.05的因素。
结果:共有1352名患者符合资格标准。在177例(22%)患者中发现了8111例(60%)患者的END隐匿性淋巴结转移。END在学术中心比非学术中心更有可能进行(赔率比:[1.66],95%置信区间[CI]:1.32-2.09,P<.001)。在多变量分析中,接受辅助放疗的患者OS较差(风险比[HR]:1.45,95%CI:1.13~3.29,P=.017).END与单变量分析的总体OS改善相关(HR:0.83,95%CI:0.69-0.98,P=.026),但不是多变量分析。
结论:在这项NCDB研究中,22%的cN0声门上型SCCa患者有隐匿性淋巴结转移疾病。尽管如此,40%的患者在初次切除时不接受END。接受END治疗声门上SCCa的患者更有可能避免辅助辐射而不影响OS。
OBJECTIVE: Identify the proportion of patients undergoing elective neck dissection (END) in surgically managed supraglottic squamous cell carcinoma (SCCa), assess associations between patient, tumor, and treatment factors with END, and assess associations between neck management and overall survival (OS).
METHODS: Retrospective study.
METHODS: National Cancer Database (NCDB) 2019 Participant User File.
METHODS: Patients with previously untreated, clinically node-negative (cN0) supraglottic SCCa treated with partial laryngectomy were queried from NCDB. Patients without known neck management and who underwent total laryngectomy were excluded. Patient and tumor factors associated with END were evaluated by logistic regression analysis. Univariable Cox proportional hazard analysis was used to examine associations between patient factors and OS, and factors with P < .05 were included on multivariable analysis.
RESULTS: A total of 1352 patients met eligibility criteria. Eight hundred eleven (60%) patients had END performed with occult nodal metastasis identified in 177 (22%) patients. END was more likely to be performed at academic centers than nonacademic centers (odds ratio: [1.66], 95% confidence interval [CI]: 1.32-2.09, P < .001). On multivariable analysis, patients who underwent adjuvant radiation had worse OS (hazard ratio [HR]: 1.45, 95% CI: 1.13-3.29, P = .017). END was associated with improved OS overall on univariable analysis (HR: 0.83, 95% CI: 0.69-0.98, P = .026), but not on multivariable analysis.
CONCLUSIONS: In this NCDB study, 22% of cN0 supraglottic SCCa patients had occult nodal metastatic disease. Despite this, 40% of patients do not receive END at the time of primary resection. Patients who receive END for supraglottic SCCa are more likely to avoid adjuvant radiation without impacting OS.