Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-institutional Analysis of 1,033 Cases

Clinical and Experimental Otorhinolaryngology

Yoo Seob Shin¹  Chul-Ho Kim¹  Min-Sik Kim²  Jun-Ook Park²  Yong Tae Hong³  Ki Hwan Hong³  Young-Mo Kim⁴  Ji Won Kim⁴  Yeon Soo Kim⁵  Jae Won Chang⁶  Phil-Sang Chung⁷  Seung Hoon Woo⁷  Ik Joon Choi⁸  Kwang-Yoon Jung⁹  Seung-Kuk Baek⁹  Woo-Jin Jeong^1,10  Soon-Hyun Ahn^1,11  Se-Heon Kim^1,12  Young Min Park^1,12 

[1] Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea;Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea;Department of Otolaryngology-Head and Neck Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea;Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, Korea;Department of Otorhinolaryngology, Konyang University College of Medicine, Daejeon, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital (KCCH), Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea;Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea;

关键词: squamous cell carcinoma of head and neck;    oral neoplasms;    oropharyngeal neoplasm;    laryngeal neoplasms;    hypopharyngeal neoplasms;    survival;    disease-free survival;    survival rate;    prognosis;    surgery;   

DOI  :  10.21053/ceo.2020.01732

来源: DOAJ

【 摘 要 】

Objectives Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). Conclusion A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

【 授权许可】

Unknown