Aman M. Patel BS, Afash Haleem BA, Lucy Revercomb BS, Jason A. Brant MD, Karthik Rajasekaran MD, Lova L. Sun MD, MSCE, Robert M. Brody MD, Ryan M. Carey MD
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Binary logistic, Kaplan–Meier, and multivariable Cox proportional hazards regression models were implemented.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (<i>p</i> < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) (<i>p</i> < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54–6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25–6.32, <i>p</i> < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38–0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21–0.66) were associated with higher OS (<i>p</i> < .005). Immunotherapy (aHR 0.48, 95% CI 0.28–0.81, <i>p</i> = .006) was also independently associated with higher OS.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.</p>\n \n <p>Level of evidence: 4.</p>\n </section>\n </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"9 5","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70000","citationCount":"0","resultStr":"{\"title\":\"Primary site surgical resection in cM1 oral cavity squamous cell carcinoma\",\"authors\":\"Aman M. Patel BS, Afash Haleem BA, Lucy Revercomb BS, Jason A. Brant MD, Karthik Rajasekaran MD, Lova L. Sun MD, MSCE, Robert M. Brody MD, Ryan M. Carey MD\",\"doi\":\"10.1002/lio2.70000\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>The 2006–2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan–Meier, and multivariable Cox proportional hazards regression models were implemented.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (<i>p</i> < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) (<i>p</i> < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54–6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25–6.32, <i>p</i> < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38–0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21–0.66) were associated with higher OS (<i>p</i> < .005). Immunotherapy (aHR 0.48, 95% CI 0.28–0.81, <i>p</i> = .006) was also independently associated with higher OS.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.</p>\\n \\n <p>Level of evidence: 4.</p>\\n </section>\\n </div>\",\"PeriodicalId\":48529,\"journal\":{\"name\":\"Laryngoscope Investigative Otolaryngology\",\"volume\":\"9 5\",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-09-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70000\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laryngoscope Investigative Otolaryngology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/lio2.70000\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope Investigative Otolaryngology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/lio2.70000","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的 研究临床远处转移性(cM1)口腔鳞状细胞癌(OCSCC)的原发部位手术切除和总生存率(OS)。 方法 对2006-2018年全国癌症数据库中接受化疗的cM1 OCSCC患者进行查询。采用二元逻辑、Kaplan-Meier和多变量Cox比例危险回归模型。 结果 在278名符合纳入标准的患者中,139人(50.0%)接受了单纯化疗,80人(28.8%)接受了化放疗,25人(9.0%)接受了手术切除+辅助化疗,34人(12.2%)接受了手术切除+辅助化放疗;5年OS分别为9.4%、15.2%、8.3%和23.8%(p< .001)。与未接受手术切除的患者相比,接受手术切除的患者接受放疗的比例更高(57.6% 对 36.5%),但接受多药化疗的比例较低(40.7% 对 74.4%)(p < .005)。21例(36.2%)接受手术切除的患者手术切缘呈阳性。学术机构(调整赔率比 [aOR] 3.19,95% CI 1.54-6.62)和 Charlson-Deyo 合并症评分≥1(aOR 2.82,95% CI 1.25-6.32,p < .025)与接受手术切除的几率增加有关。与单纯化疗相比,化放疗(调整后危险比[aHR] 0.56,95% CI 0.38-0.83)和手术切除+辅助化放疗(aHR 0.37,95% CI 0.21-0.66)与较高的OS相关(p < .005)。免疫治疗(aHR 0.48,95% CI 0.28-0.81,p = .006)也与较高的 OS 独立相关。 结论 少数 cM1 OCSCC 患者接受了原发部位手术切除。尽管手术切缘阳性率较高,但与单纯化疗、化放疗或手术切除+辅助化疗相比,手术切除+辅助化放疗与较高的OS相关。确定性局部治疗可使部分cM1 OCSCC患者获益。 证据级别:4.
Primary site surgical resection in cM1 oral cavity squamous cell carcinoma
Objective
To investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC).
Methods
The 2006–2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan–Meier, and multivariable Cox proportional hazards regression models were implemented.
Results
Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (p < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) (p < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54–6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25–6.32, p < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38–0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21–0.66) were associated with higher OS (p < .005). Immunotherapy (aHR 0.48, 95% CI 0.28–0.81, p = .006) was also independently associated with higher OS.
Conclusion
A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.