pT4期喉癌喉切除术后延迟及未行术后放疗的预测因素

文献信息

中文摘要

背景： 术后放疗（PORT）可改善高危头颈部肿瘤的局部区域控制和生存，指南推荐在手术后42天内开始。对于病理性T4（pT4）期喉癌行喉切除术后的及时性，目前特征描述不足。
方法： 在一项回顾性国家癌症数据库队列中，纳入2010年至2022年接受全喉切除术的非转移性pT4期喉鳞状细胞癌成人患者，采用多变量logistic回归识别延迟（术后43-180天接受放疗）和未行PORT的预测因素，并采用90天地标Cox模型根据手术至PORT间隔评估总生存。
结果： 在6079例患者中，21.2%接受了及时PORT，66.2%延迟，12.6%在180天内未行PORT。每延迟一周，调整后死亡风险增加3.7%。延迟与在非手术机构接受放疗相关。淋巴结阳性疾病与延迟的较高几率相关，但与未行PORT的较低几率相关。未行PORT还与年龄较大、合并症较多和社区收入较低相关。
结论： 喉切除术后及时PORT较为罕见；延迟和未行PORT与不同的因素相关，可能受益于针对性的干预措施。

英文摘要

BACKGROUND: Postoperative radiotherapy (PORT) improves locoregional control and survival in high-risk head and neck cancer, and guidelines recommend initiation within 42 days of surgery. Timeliness after laryngectomy for pathologic T4 (pT4) laryngeal cancer is poorly characterized.
METHODS: In a retrospective National Cancer Database cohort of adults with nonmetastatic pT4 laryngeal squamous cell carcinoma undergoing total laryngectomy (2010-2022), multivariable logistic regression identified predictors of delayed (43-180 days post-operative receipt) and omitted PORT, and a 90-day landmark Cox model evaluated overall survival based on surgery-to-PORT interval.
RESULTS: Among 6079 patients, 21.2% received timely PORT, 66.2% delayed, and 12.6% omitted within 180 days. Each additional week of delay carried a 3.7% higher adjusted mortality risk. Delay was associated with receipt of radiation at a facility other than the operating institution. Node-positive disease was associated with higher odds of delay but lower odds of omission. Omission was also associated with older age, greater comorbidity, and lower neighborhood income.
CONCLUSIONS: Timely PORT after laryngectomy is rare; delays and omissions are associated with distinct factors that may benefit from specific interventions.