局部区域晚期下咽癌初始化疗与初始手术联合初始放疗的比较研究

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2025-06-18 DOI:10.1016/j.clon.2025.103890

D.-w. Zhao , H.-y. Jiang , W.-j. Fan , L.-l. Meng , Y.-j. Qu , G.-b. Ren , X.-f. Guo , C.-l. Liu , B.-n. Cai , P.-g. Wang , L. Ma

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引用次数: 0

摘要

背景喉保存是治疗局部晚期下咽癌（LAHPC）的关键治疗目标。本研究比较了诱导化疗+同步放化疗（IcRT）和手术+放疗或同步放化疗（SurRT）对LAHPC患者的疗效。方法本研究纳入182例接受IcRT （n = 137）或SurRT （n = 45）治疗的LAHPC患者。分析喉功能生存期（SFL）、总生存期（OS）、无进展生存期（PFS）、局部无故障生存期（LFFS）、局部区域无故障生存期（LRFFS）和远端无转移生存期（DMFS）。采用倾向评分匹配（PSM）来平衡两个治疗组之间的基线特征。结果IcRT组5年SFL明显优于SurRT组(50.4% vs. 30.5%, HR 2.38, 95% CI 1.40-4.03, P <；0.001)。然而，两组在psm前后的5年OS （55.2% vs. 56.8%, HR 0.80, P = 0.41）、PFS （48.5% vs. 45.7%, HR 0.99, P = 0.99）、LFFS （55.1% vs. 57.7%, HR 0.86, P = 0.57）或DMFS （50.2% vs. 42.8%, HR 1.02, P = 0.90）方面均无显著差异。IcRT组表现出更大的辐射相关毒性，但获得了更好的局部控制和远处转移率，而SurRT组的区域复发率较低。T分类和临床分期被确定为生存结果的独立预后因素。结论：与SurRT相比，sicrt可以在特定患者中提供更好的喉保护，尽管具有更高的急性毒性。治疗决定应优先考虑肿瘤预后和患者耐受性。

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A Comparative Study of Initiated Chemotherapy Versus Initiated Surgery Combined with Primary-Radiotherapy in Locoregionally Advanced Hypopharyngeal Carcinoma

Background

Laryngeal preservation is a pivotal treatment goal in managing locally advanced hypopharyngeal carcinoma (LAHPC). This study compares the outcomes of induction chemotherapy followed by concurrent chemoradiotherapy (IcRT) and surgery followed by radiotherapy or concurrent chemoradiotherapy (SurRT) in patients with LAHPC.

Methods

This study included 182 patients with LAHPC treated with either IcRT (n = 137) or SurRT (n = 45). Survival with a functional larynx (SFL), overall survival (OS), progression-free survival (PFS), local failure-free survival (LFFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) were analyzed. Propensity score matching (PSM) was performed to balance baseline characteristics between the two treatment groups.

Results

The IcRT group demonstrated significantly superior 5-yr SFL compared to the SurRT group (50.4% vs. 30.5%, HR 2.38, 95% CI 1.40–4.03, P < 0.001). However, there were no significant differences between the two groups in 5-yr OS (55.2% vs. 56.8%, HR 0.80, P = 0.41), PFS (48.5% vs. 45.7%, HR 0.99, P = 0.99), LFFS (55.1% vs. 57.7%, HR 0.86, P = 0.57), or DMFS (50.2% vs. 42.8%, HR 1.02, P = 0.90), in both pre- and post-PSM analyses. The IcRT group exhibited greater radiation-related toxicities but achieved better local control and distant metastasis rates, while the SurRT group had a lower rate of regional recurrence. T classification and clinical stage were identified as independent prognostic factors for survival outcomes.

Conclusions

IcRT may offer enhanced laryngeal preservation compared to SurRT in select patients, albeit with higher acute toxicities. Treatment decisions should prioritize both oncologic outcomes and patient tolerance.

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来源期刊

Clinical oncology 医学-肿瘤学

CiteScore

5.20

自引率

8.80%

发文量

332

审稿时长

40 days

期刊介绍： Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.