Preoperative Clinical and Tumor Factors Associated With Adjuvant Therapy for Oral Cavity Cancer.

IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY
Gabriel S Dayan, Houda Bahig, Justine Colivas, Antoine Eskander, Stephanie Johnson-Obaseki, Shamir Chandarana, John R de Almeida, Anthony C Nichols, Michael Hier, Mathieu Belzile, Andrea Avagnina, Xinyuan Hong, Marc Gaudet, T Wayne Matthews, Robert Hart, David P Goldstein, Ali Hosni, Danielle MacNeil, James Fowler, Carlos Khalil, Mark Khoury, Gregoire Morand, Khalil Sultanem, Tareck Ayad, Apostolos Christopoulos
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引用次数: 0

Abstract

Importance: The standard of care for patients with oral cavity squamous cell carcinoma (OCSCC) is generally primary surgical resection with or without adjuvant therapy (AT), based on pathological factors. Identifying preoperative factors that are associated with the receipt of AT may enhance treatment planning.

Objective: To identify preoperative patient and tumor factors associated with receiving AT, either radiation therapy (RT) or chemoradiation therapy (CRT), in patients with OCSCC.

Design, setting, and participants: This cohort study, spanning January 2005 to December 2019 at 9 academic centers in Canada, was conducted as part of the Canadian Head & Neck Collaborative Research Initiative, a national network of head and neck surgical oncologists. Participants included patients with oral cavity cancer who underwent surgery. The data analysis was performed in March 2024.

Exposures: Preoperative variables, including demographics (age, sex, smoking history, and Charlson Comorbidity Index [CCI]) and tumor characteristics (clinical T and N stage, biopsy grade, tumor size).

Main outcomes and measures: The main outcomes were the receipt of AT vs surgery alone; the type of AT, either RT or CRT; and the presence of a strong pathologic indicator for AT.

Results: Of the 3980 patients, 2438 underwent surgery alone (61%) and 1542 received AT (39%). Of these, 1907 (48%) had a strong pathologic indicator for AT. The mean (SD) age was 63 (13) years, and 1498 participants (38%) were female. On multivariable analysis, factors independently associated with AT included being older than 65 years (odds ratio [OR], 0.50 [95% CI, 0.38-0.64]), CCI of 4 or higher (OR, 1.83 [95% CI, 1.26-2.65]), previous head and neck cancer (OR, 0.40 [95% CI, 0.26-0.62]), maxillary alveolus (OR, 2.16 [95% CI, 1.11-4.22]) and retromolar trigone (OR, 1.85 [95% CI, 1.04-3.29) subsites, tumor dimension (OR, 1.35 [95% CI, 1.22-1.50] per cm), increasing clinical T and N stages, and worse grade on biopsy (poorly differentiated: OR, 1.89 [95% CI, 1.25-2.84]). Among those receiving AT, poorly differentiated grade (OR, 2.40 [95% CI, 1.34-4.30]) and advanced N stage were associated with CRT rather than RT. Among patients with strong pathologic indicators for AT, factors associated with not receiving AT included age, CCI, grade, stage, and tumor dimension. The prediction model showed good discriminatory power (area under the receiver operating characteristic curve, 0.84 [95% CI, 0.82-0.86]).

Conclusions and relevance: The results of this cohort study suggest that preoperative variables can help to identify patients with OCSCC who are more likely to receive AT, despite many factors not being predictable until the postoperative period. Early identification of patients at high risk may improve treatment planning and reduce delays in initiating AT, potentially enhancing patient outcomes.

与口腔癌辅助治疗相关的术前临床和肿瘤因素。
重要性:口腔鳞状细胞癌(OCSCC)患者的护理标准通常是基于病理因素的初级手术切除或不进行辅助治疗(AT)。确定术前与接受AT相关的因素可以提高治疗计划。目的:确定术前患者和肿瘤因素与接受放射治疗(RT)或放化疗(CRT)的OCSCC患者相关。设计、环境和参与者:这项队列研究于2005年1月至2019年12月在加拿大的9个学术中心进行,是加拿大头颈合作研究计划的一部分,该计划是一个全国性的头颈外科肿瘤学家网络。参与者包括接受过手术的口腔癌患者。数据分析于2024年3月进行。暴露:术前变量,包括人口统计学(年龄、性别、吸烟史和Charlson共病指数[CCI])和肿瘤特征(临床T和N分期、活检分级、肿瘤大小)。主要结果和措施:主要结果是接受AT与单纯手术;AT的类型,是RT还是CRT;以及存在强烈的AT病理指标。结果:3980例患者中,单纯手术2438例(61%),AT 1542例(39%)。其中,1907例(48%)有强烈的AT病理指标。平均(SD)年龄为63(13)岁,1498名参与者(38%)为女性。在多变量分析中,与AT相关的独立因素包括年龄大于65岁(比值比[OR], 0.50 [95% CI, 0.38-0.64])、CCI为4或更高(OR, 1.83 [95% CI, 1.26-2.65])、既往头颈癌(OR, 0.40 [95% CI, 0.26-0.62])、上颌牙槽(OR, 2.16 [95% CI, 1.11-4.22])和臼齿后三角区(OR, 1.85 [95% CI, 1.04-3.29)亚位、肿瘤尺寸(OR, 1.35 [95% CI, 1.22-1.50] / cm)、临床T和N分期增加、活检分级较差(低分化:OR, 1.89 [95% CI, 1.25-2.84])。在接受AT的患者中,低分化分级(OR, 2.40 [95% CI, 1.34-4.30])和N期晚期与CRT相关,而不是rt。在AT病理指标较强的患者中,与不接受AT相关的因素包括年龄、CCI、分级、分期和肿瘤尺寸。该预测模型具有良好的判别能力(受试者工作特征曲线下面积为0.84 [95% CI, 0.82-0.86])。结论及相关性:本队列研究的结果表明,术前变量可以帮助识别更有可能接受AT的OCSCC患者,尽管许多因素直到术后才可预测。早期识别高风险患者可以改善治疗计划,减少启动at的延误,潜在地提高患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.10
自引率
5.10%
发文量
230
期刊介绍: JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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