Survival Associations of Timely Postoperative Radiotherapy Among Head and Neck Cancer High-Risk Subgroups

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-02-17 DOI:10.1002/lary.32074

Lisa M. Velez Velez, Timothy V. Corpuz, Luke C. Schwetschenau, Angela Mazul, Sean T. Massa

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Abstract

Objective

Effective implementation of timely postoperative radiation therapy (PORT) as a quality metric for head and neck squamous cell carcinoma (HNSCC) care may reduce survival disparities in subgroups with the highest risk of mortality—advanced stage and Black race. We sought to determine if the association between timely PORT and survival varies among clinical and demographic high-risk subgroups.

Methods

In this retrospective cohort study using the National Cancer Database 2004–2020, patients with HPV-negative HNSCC treated with surgery and PORT were identified. The association between PORT delay greater than 6 weeks with overall survival was assessed by Cox proportional hazards models with interaction effects for race, overall stage, and PORT delay.

Results

Among 54,035 patients included in the study, 62% (33491) had PORT delays. Black patients were more likely to have PORT delays (aOR 1.19, 95% CI: 1.10–1.27). Timely PORT was only associated with improved survival for all stage I patients and White stage IV patients (predicted mortality risk 2.53, 95% CI: 2.34–2.74 versus 2.88, 95% CI: 2.67–3.09, referenced to White, stage I). After adjusting for covariates, timely PORT was estimated to be associated with inferior overall survival in Black patients with stage IV disease although with low precision (predicted mortality risk 3.24, 95% CI: 2.87–3.66, versus 2.71, 95% CI: 2.47–2.98, referenced to White, stage I).

Conclusion

Timely, guideline-adherent PORT may not reduce survival disparities in Black patients, especially those with advanced stage disease, suggesting other interventions are needed to address this disparity.

Level of Evidence

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头颈癌高危亚组术后及时放疗的生存相关性

目的：有效实施及时的术后放射治疗（PORT）作为头颈部鳞状细胞癌（HNSCC）护理的质量指标，可能会减少死亡风险最高的亚组（晚期和黑人）的生存差异。我们试图确定在临床和人口统计学高危亚组中，及时PORT与生存之间的关系是否有所不同。方法：在这项使用2004-2020年国家癌症数据库的回顾性队列研究中，确定了接受手术和PORT治疗的hpv阴性HNSCC患者。PORT延迟大于6周与总生存期之间的关系通过Cox比例风险模型进行评估，该模型具有种族、总分期和PORT延迟的相互作用效应。结果：在纳入研究的54,035例患者中，62%（33491）发生PORT延迟。黑人患者更有可能出现PORT延迟（aOR 1.19, 95% CI: 1.10-1.27）。及时PORT仅与所有I期患者和白人IV期患者的生存率改善相关（预测死亡风险2.53,95% CI: 2.34-2.74, 95% CI: 2.88, 95% CI: 2.67-3.09，参照白人I期患者）。在调整了相关变量后，估计及时PORT与黑人IV期患者的总生存率较低相关，尽管精度较低（预测死亡风险3.24,95% CI: 2.87-3.66, 95% CI: 2.71）。2.47-2.98，参考White， I期)。结论：及时的、遵循指南的PORT可能不会减少黑人患者的生存差异，特别是那些疾病晚期的患者，这表明需要其他干预措施来解决这一差异。证据等级：3；

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects