cT4b 鼻窦非鳞癌的手术切除和总生存率。

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-10-23 DOI:10.1002/lio2.70025

Aman M. Patel BS, Afash Haleem BA, Lucy Revercomb BS, Jason A. Brant MD, Michael A. Kohanski MD, PhD, Nithin D. Adappa MD, James N. Palmer MD, Jennifer E. Douglas MD, Ryan M. Carey MD

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引用次数: 0

摘要

目的：对于cT4b鼻窦鳞状细胞癌（SCC），手术切除比确定性放疗（RT）或化放疗（CRT）具有更高的总生存率（OS）。我们的研究调查了手术切除对cT4b鼻窦非SCC的生存益处：我们查询了2004年至2019年全国癌症数据库中接受（1）手术切除+附加治疗（RT、化疗或两者）、（2）单纯RT或（3）CRT明确治疗的cT4b鼻窦非SCC患者。通过 Kaplan-Meier 模型和多变量 Cox 回归模型对手术切除+附加疗法和确定性 RT/CRT 进行了比较：在符合纳入标准的 629 例患者中，513 例（81.6%）接受了手术切除+附加治疗，116 例（18.4%）接受了明确的 RT/CRT。最常见的组织学类型是未分化癌（23.7%）、腺样囊性癌（22.6%）和腺癌（20.7%）。少数患者出现临床结节转移（15.7%）。手术切除后 90 天内有 4 例（0.8%）死亡。接受手术切除且手术切缘阳性的患者的5年生存率高于接受确定性RT/CRT的患者（56.3% vs. 39.4%，p = .039），与切缘阴性的患者的5年生存率相似（56.3% vs. 63.9%，p = .059）。接受新辅助化疗的患者的5年生存率与接受最终RT/CRT治疗的患者相似（60.9% vs. 39.5%，p = .053）。诊断时的年龄、肿瘤直径和手术切除+额外治疗（aHR 0.64，95% CI 0.45-0.91）与OS相关（p 结论：手术切除+额外治疗（aHR 0.64，95% CI 0.45-0.91）与OS相关：对于cT4b鼻窦非SCC患者，手术切除+额外治疗比确定性RT/CRT具有更高的OS。手术切除可使部分cT4b鼻窦鼻腔非SCC患者获益：4.

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Surgical resection and overall survival in cT4b sinonasal non-squamous cell carcinoma

Objective

Surgical resection is associated with higher overall survival (OS) than definitive radiotherapy (RT) or chemoradiotherapy (CRT) in cT4b sinonasal squamous cell carcinoma (SCC). Our study investigates the survival benefit of surgical resection in cT4b sinonasal non-SCC.

Methods

The 2004 to 2019 National Cancer Database was queried for patients with cT4b sinonasal non-SCC undergoing definitive treatment with (1) surgical resection + additional therapy (RT, chemotherapy, or both), (2) RT alone, or (3) CRT. Surgical resection + additional therapy and definitive RT/CRT were compared with Kaplan–Meier and multivariable Cox regression models.

Results

Of 629 patients satisfying inclusion criteria, 513 (81.6%) underwent surgical resection + additional therapy and 116 (18.4%) underwent definitive RT/CRT. The most frequent histologic types were undifferentiated carcinoma (23.7%), adenoid cystic carcinoma (22.6%), and adenocarcinoma (20.7%). Few patients presented with clinical nodal metastasis (15.7%). There were 4 (0.8%) mortalities within 90 days of surgical resection. Patients undergoing surgical resection with positive surgical margins had higher 5-year OS than those undergoing definitive RT/CRT (56.3% vs. 39.4%, p = .039) and similar 5-year OS as those with negative margins (56.3% vs. 63.9%, p = .059). Patients undergoing neoadjuvant chemotherapy had similar 5-year OS as those undergoing definitive RT/CRT (60.9% vs. 39.5%, p = .053). Age at diagnosis, tumor diameter, and surgical resection + additional therapy (aHR 0.64, 95% CI 0.45–0.91) were associated with OS (p < .05).

Conclusion

Surgical resection + additional therapy was associated with higher OS than definitive RT/CRT in cT4b sinonasal non-SCC. Surgical resection may benefit select patient with cT4b sinonasal non-SCC.