晚期口咽癌手术与非手术干预的比较结果：一项大规模回顾性队列研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-10-10 DOI:10.1002/lio2.70279

Khang Win Vu, Martha Watson, Abdallah Attia, Ahmed Abdelmaksoud, Manal S. Fawzy, Eman A. Toraih

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引用次数: 0

摘要

目的比较口咽癌手术与非手术治疗的短期并发症和长期生存情况。方法：我们使用TriNetX全球协作网络进行了一项大规模回顾性队列研究，分析了来自128个医疗机构的154,494,403名患者的数据。应用纳入标准和倾向评分匹配后，我们比较了2413例手术患者和2413例非手术患者。主要结局包括6个月时的短期并发症（吞咽困难、胃造口管置入、气管造口术、呼吸并发症）和5年全因死亡率。结果术后6个月，手术患者出现吞咽困难（46.83%比40.61%,RR = 1.15, 95% CI: 1.08-1.23）和呼吸系统并发症（6.30%比3.69%,RR = 1.71, 95% CI: 1.32-2.21）的比例较高。非手术患者胃造口置管率（17.86%比6.09%,RR = 0.34, 95% CI: 0.29-0.41）和气管造口率（7.34%比3.61%,RR = 0.49, 95% CI: 0.38-0.63）均有所增加。同样，晚期队列的亚组分析显示，非手术患者胃造口置管率（5.5%比17.5%,RR = 0.31, CI: 0.19-0.52）和气管造口率（3.1%比6.4%,RR = 0.48, CI: 0.23-0.99）更高。在5年随访中，手术干预与全因死亡率显著降低相关（9.9% vs. 25.3%, HR = 0.43, 95% CI: 0.37-0.49）。这种生存优势在晚期亚组中持续存在（14.1% vs. 25.5%, HR = 0.53, 95% CI: 0.37-0.76）（p < 0.001）。结论：虽然口咽癌的手术治疗与某些短期并发症的发生率较高相关，但与非手术干预相比，它显示出更好的长期生存结果，包括晚期疾病患者。这些发现为口咽癌的治疗选择和患者咨询提供了有价值的证据。证据级别2b。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Comparative Outcomes of Surgical vs. Non-Surgical Interventions in Advanced Oropharyngeal Cancer: A Large-Scale Retrospective Cohort Study

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Comparative Outcomes of Surgical vs. Non-Surgical Interventions in Advanced Oropharyngeal Cancer: A Large-Scale Retrospective Cohort Study

Objective

To compare short-term complications and long-term survival outcomes between surgical and non-surgical treatments for oropharyngeal cancer.

Methods

We conducted a large-scale retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data from 154,494,403 patients across 128 healthcare organizations. After applying inclusion criteria and propensity score matching, we compared 2413 surgical patients with 2413 non-surgical patients. Primary outcomes included short-term complications at 6 months (dysphagia, gastrostomy tube placement, tracheostomy, respiratory complications) and 5-year all-cause mortality.

Results

At 6 months post-treatment, surgical patients showed higher rates of dysphagia (46.83% vs. 40.61%, RR = 1.15, 95% CI: 1.08–1.23) and respiratory complications (6.30% vs. 3.69%, RR = 1.71, 95% CI: 1.32–2.21). Non-surgical patients experienced increased rates of gastrostomy tube placement (17.86% vs. 6.09%, RR = 0.34, 95% CI: 0.29–0.41) and tracheostomy (7.34% vs. 3.61%, RR = 0.49, 95% CI: 0.38–0.63). Similarly, subgroup analysis of the advanced-stage cohort showed that non-surgical patients had higher rates of gastrostomy tube placement (5.5% vs. 17.5%, RR = 0.31, CI: 0.19–0.52) and tracheostomy (3.1% vs. 6.4%, RR = 0.48, CI: 0.23–0.99). At 5-year follow-up, surgical intervention was associated with significantly lower all-cause mortality (9.9% vs. 25.3%, HR = 0.43, 95% CI: 0.37–0.49). This survival benefit persisted in the advanced-stage subgroup (14.1% vs. 25.5%, HR = 0.53, 95% CI: 0.37–0.76) (p < 0.001).

Conclusions

While surgical treatment for oropharyngeal cancer was associated with higher rates of certain short-term complications, it demonstrated superior long-term survival outcomes compared to non-surgical interventions, including in patients with advanced disease. These findings provide valuable evidence to inform treatment selection and patient counseling in oropharyngeal cancer management.