Dylan J Cooper, Camron Davies, Paul Putnam, James B Tansey, John Gleysteen, Eugene R Sansoni, David L Schwartz, Carey Burton Wood
{"title":"晚期喉癌辅助放射治疗的实际生存影响和使用情况","authors":"Dylan J Cooper, Camron Davies, Paul Putnam, James B Tansey, John Gleysteen, Eugene R Sansoni, David L Schwartz, Carey Burton Wood","doi":"10.1177/01455613241291701","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> Optimal treatment of locally advanced cancer of the larynx is controversial. In this study, we aim to compare outcomes in patients with T3-4N0-1 cancer of the larynx who underwent surgery alone versus surgery followed by radiation therapy (RT). <b>Materials and Methods:</b> A total of 1820 patients with advanced laryngeal cancer were identified from the national Surveillance, Epidemiology, and End Results Database and stratified based on postoperative RT status, and clinical outcomes were compared between these 2 groups. Propensity score matching was conducted to balance baseline characteristics. <b>Results:</b> The majority of patients (53.4%) received adjuvant RT. N0 patients who received laryngectomy and who did not undergo adjuvant radiation had a 47% higher risk of cancer-specific death than patients receiving adjuvant RT (adj. HR 1.47, 95% CI 1.18-1.84). N1 patients who did not undergo adjuvant radiation had a 90% higher risk of cancer-specific death than patients receiving RT after surgery (adj. HR 1.90, 95% CI 1.27-2.84). After adjusting for propensity scores, adjuvant RT carried a significant overall survival benefit (HR 0.73, 95% CI 0.60-0.87). <b>Conclusions</b>: This study provides real-world support for adjuvant radiation in patients with T3-4N0-1 laryngeal carcinoma. Nearly half of patients did not receive RT, indicating a need for national provider education and process improvement strategies to improve utilization.</p>","PeriodicalId":93984,"journal":{"name":"Ear, nose, & throat journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Real-World Survival Impact and Utilization of Adjuvant Radiation in Advanced Laryngeal Cancer.\",\"authors\":\"Dylan J Cooper, Camron Davies, Paul Putnam, James B Tansey, John Gleysteen, Eugene R Sansoni, David L Schwartz, Carey Burton Wood\",\"doi\":\"10.1177/01455613241291701\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> Optimal treatment of locally advanced cancer of the larynx is controversial. In this study, we aim to compare outcomes in patients with T3-4N0-1 cancer of the larynx who underwent surgery alone versus surgery followed by radiation therapy (RT). <b>Materials and Methods:</b> A total of 1820 patients with advanced laryngeal cancer were identified from the national Surveillance, Epidemiology, and End Results Database and stratified based on postoperative RT status, and clinical outcomes were compared between these 2 groups. Propensity score matching was conducted to balance baseline characteristics. <b>Results:</b> The majority of patients (53.4%) received adjuvant RT. N0 patients who received laryngectomy and who did not undergo adjuvant radiation had a 47% higher risk of cancer-specific death than patients receiving adjuvant RT (adj. HR 1.47, 95% CI 1.18-1.84). N1 patients who did not undergo adjuvant radiation had a 90% higher risk of cancer-specific death than patients receiving RT after surgery (adj. HR 1.90, 95% CI 1.27-2.84). After adjusting for propensity scores, adjuvant RT carried a significant overall survival benefit (HR 0.73, 95% CI 0.60-0.87). <b>Conclusions</b>: This study provides real-world support for adjuvant radiation in patients with T3-4N0-1 laryngeal carcinoma. Nearly half of patients did not receive RT, indicating a need for national provider education and process improvement strategies to improve utilization.</p>\",\"PeriodicalId\":93984,\"journal\":{\"name\":\"Ear, nose, & throat journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ear, nose, & throat journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/01455613241291701\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ear, nose, & throat journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/01455613241291701","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:局部晚期喉癌的最佳治疗方法尚存争议。本研究旨在比较 T3-4N0-1 喉癌患者单纯手术与手术后放疗(RT)的疗效。材料与方法:从国家监测、流行病学和最终结果数据库中确定了1820名晚期喉癌患者,并根据术后RT状态进行了分层,比较了两组患者的临床疗效。为平衡基线特征,进行了倾向评分匹配。结果:大多数患者(53.4%)接受了辅助 RT。与接受辅助 RT 的患者相比,接受喉切除术且未接受辅助放射治疗的 N0 患者的癌症特异性死亡风险高出 47%(辅助 HR 1.47,95% CI 1.18-1.84)。未接受辅助放射治疗的 N1 患者的癌症特异性死亡风险比术后接受 RT 的患者高 90%(adj. HR 1.90,95% CI 1.27-2.84)。在对倾向评分进行调整后,辅助 RT 可显著提高总生存率(HR 0.73,95% CI 0.60-0.87)。结论:这项研究为T3-4N0-1喉癌患者的辅助放射治疗提供了现实支持。近一半的患者没有接受RT治疗,这表明有必要在全国范围内开展医疗服务提供者教育并制定流程改进策略,以提高利用率。
Real-World Survival Impact and Utilization of Adjuvant Radiation in Advanced Laryngeal Cancer.
Background: Optimal treatment of locally advanced cancer of the larynx is controversial. In this study, we aim to compare outcomes in patients with T3-4N0-1 cancer of the larynx who underwent surgery alone versus surgery followed by radiation therapy (RT). Materials and Methods: A total of 1820 patients with advanced laryngeal cancer were identified from the national Surveillance, Epidemiology, and End Results Database and stratified based on postoperative RT status, and clinical outcomes were compared between these 2 groups. Propensity score matching was conducted to balance baseline characteristics. Results: The majority of patients (53.4%) received adjuvant RT. N0 patients who received laryngectomy and who did not undergo adjuvant radiation had a 47% higher risk of cancer-specific death than patients receiving adjuvant RT (adj. HR 1.47, 95% CI 1.18-1.84). N1 patients who did not undergo adjuvant radiation had a 90% higher risk of cancer-specific death than patients receiving RT after surgery (adj. HR 1.90, 95% CI 1.27-2.84). After adjusting for propensity scores, adjuvant RT carried a significant overall survival benefit (HR 0.73, 95% CI 0.60-0.87). Conclusions: This study provides real-world support for adjuvant radiation in patients with T3-4N0-1 laryngeal carcinoma. Nearly half of patients did not receive RT, indicating a need for national provider education and process improvement strategies to improve utilization.