术后放疗在声门上型喉鳞状细胞癌治疗中的价值

Evaluation of postoperative radiotherapy in the treatment of supraglottic laryngeal squamous cell carcinoma

摘要:

目的 评估手术后辅助放疗（postoperative radiotherapy，PORT）在声门上型喉鳞状细胞癌治疗中的作用。方法 搜集美国监测、流行病学和最终结果（Surveillance，Epidemiology，and End Results，SEER）数据库中2004年至2015年接受手术治疗的831例声门上型喉鳞状细胞癌患者的临床资料，根据术后是否接受放疗分为PORT（-）组及PORT（+）组，应用倾向性评分匹配法（propensity score matching，PSM）均衡2组间变量的差异，采用Kaplan-Meier及log-rank检验进行生存分析并进行亚组分析，比较2组间总生存（overall survival，OS）和肿瘤特异性生存（cancer specific survival，CSS）的差异，分析PORT在声门上型喉鳞状细胞癌患者治疗中的价值及获益人群。结果 倾向性评分匹配前，PORT（-）组及PORT（+）组的OS无统计学差异，而PORT（+）组的CSS较PORT（-）组更差（P=0.022）。对阳性淋巴数的亚组分析显示，阳性淋巴结数为0和1的患者，PORT（-）组与PORT（+）组的OS与CSS均无统计学差异；但在阳性淋巴结数>1的患者中，PORT（+）组的5年OS与CSS均较PORT（-）组更好（OS：23.1% vs. 38.1%，P<0.001；CSS：34.8% vs. 45.3%，P=0.004）。进行倾向性评分匹配后，PORT（+）组较PORT（-）组的OS及CSS均更好（OS：55.1% vs. 41.9%，P=0.004；CSS：67.1% vs. 56.1%，P=0.042）。亚组分析显示，组织学分级Ⅰ、Ⅱ级，AJCC T4期，AJCC N2b、N2c期，阳性淋巴结数>1及全喉切除术的患者，PORT（+）组在OS及CSS中均获益，且有统计学意义。而未接受化疗、阳性淋巴结比率<20%及肿瘤大小<30 mm的患者仅存在OS获益。结论 PORT能提高部分声门上型喉鳞状细胞癌患者的生存率，相关获益人群为AJCC T4期、AJCC N2b及以上分期、阳性淋巴结数>1的患者。还需要在同类研究中进一步评估PORT在具有不良病理特征患者中的价值。

Abstract:

Objective To evaluate the role of postoperative radiotherapy（PORT） in supraglottic laryngeal squamous cell carcinoma.Methods The clinical data of 831 patients with supraglottic laryngeal squamous cell carcinoma selected from the SEER（Surveillance，Epidemiology，and End Results）database who received surgical treatment in 2004 to 2015 were retrospectively analyzed. Propensity score matching（PSM） was used to balance the covariate bias between the PORT（-） and PORT（+） groups. The survival curves were drawn by Kaplan-Meier method，and log-rank test was used to check survival difference of two groups and make subgroup analysis. And the overall survival（OS） and cancer specific survival（CSS） were compared between these two groups to analyze the value of PORT in the treatment of patients with supraglottic laryngeal squamous cell carcinoma.Results There was no significant difference in OS between the PORT（-） and PORT（+） groups before the PSM，while the CSS of the PORT（+） group was lower than that of the PORT（-） group（P=0.022）. The subgroup analysis of the number of positive lymph nodes showed that there was no significant difference in OS and CSS of patients with 0 or 1 positive lymph node. However，the patients with positive lymph nodes greater than 1 in PORT（+）group had significantly higher 5-year OS and CSS rate than those in the PORT（-）group（OS：23.1% vs. 38.1%，P<0.001；CSS： 34.8% vs. 45.3%，P=0.004）. After PSM，the OS and CSS rate in the PORT（+） group were both better than those of the PORT（-） group（OS： 55.1% vs. 41.9%，P=0.004；CSS：67.1% vs. 56.1%，P=0.042）. When analyzed by subgroup，patients with histological Ⅰ and Ⅱ stage，AJCC T4 stage，AJCC N2b stage or above，count of positive lymph nodes >1 and total laryngectomy had survival benefit for the PORT（+） group，with significant differences. And patients with lymph node ratio <20% and tumor size <30 mm without chemotherapy only had OS benefit associated with PORT.Conclusion The use of PORT can improve the OS and CSS rate in supraglottic laryngeal squamous cell carcinoma，and the related beneficiary groups are patients with AJCC T4 stage，AJCC N2b stage or above，and the count of positive lymph nodes >1，which needs to be further evaluated for the role of PORT in patients with adverse pathological features in other similar studies.