目的:本研究旨在比较放化疗(CRT)与单纯放疗(RT)治疗老年患者(≥65岁)IV期不能手术的头颈部肿瘤(IV-HNC)的疗效。
方法:使用SEER数据库确定了2010年至2015年诊断为无法手术的IV-HNC的老年患者。然后,我们进行了1:1倾向评分匹配(PSM)分析,以减少治疗选择偏倚,使用Kaplan-Meier分析研究CRT的预后作用,对数秩检验,和Cox比例风险模型。主要结果是总生存期(OS),次要结局是癌症特异性生存率(CSS).
结果:共纳入3318例患者,其中601只接受了RT,2717只接受了CRT。通过PSM,526例患者成功匹配,并达到两个治疗组之间的平衡。在匹配的数据集中,多变量Cox分析显示CRT与较好的OS(HR=0.580,P<0.001)和CSS(HR=0.586,P<0.001)相关。同时,IV-HNC患者亚组(年龄较小,男性,结婚了,黑人种族,I-II级,口腔部位,T3-T4级,N0-N1级,M1期)倾向于从CRT治疗中受益更多。此外,CRT的生存获益在65至80岁的患者中更为明显,但在80岁或以上的患者中不存在。
结论:这项研究表明,在无法手术的IV-HNC老年患者中,CRT比单纯RT具有更好的生存率。特别是对于那些受益于CRT治疗的亚群。
OBJECTIVE: This study aimed to compare the efficacy of chemoradiotherapy (CRT) with radiotherapy (RT) alone for elderly patients (≥ 65 years) with stage IV inoperable head and neck cancer (IV-HNC).
METHODS: Elderly patients diagnosed with inoperable IV-HNC from 2010 to 2015 were identified using the SEER database. Then, we performed a 1:1 propensity-score matched (PSM) analysis to reduce treatment selection bias, and the prognostic role of CRT was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The main outcome was overall survival (OS), and the secondary outcome was cancer-specific survival (CSS).
RESULTS: A total of 3318 patients were enrolled, of whom 601 received RT alone and 2717 received CRT. Through PSM, 526 patients were successfully matched, and balances between the two treatment groups were reached. In the matched dataset, multivariable Cox analysis revealed that CRT was associated with better OS (HR = 0.580, P < 0.001) and CSS (HR = 0.586, P < 0.001). Meanwhile, subgroups of patients with IV-HNC (younger age, male sex, being married, black race, grade I-II, oral cavity site, T3-T4 stage, N0-N1 stage, M1 stage) were inclined to benefit more from CRT treatment. Furthermore, the survival benefit of CRT was more pronounced in patients aged 65 to 80 years, but was absent in patients aged 80 years or older.
CONCLUSIONS: This study indicated that CRT resulted in better survival than RT alone in elderly patients with inoperable IV-HNC, especially for those subpopulations that benefit more from CRT treatment.