选定T3-T4a N0-N1期喉癌中根治性放化疗与全喉切除术后辅助治疗的比较：结局对比
Definitive Chemoradiotherapy Versus Total Laryngectomy Followed by Postoperative Therapy in Selected T3-T4a N0-N1 Laryngeal Cancer: Comparative Outcomes.
文献信息
| PMID | 42794932 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ozlem Ozkaya Akagunduz |
| 作者单位 | Department of Radiation Oncology, Ege University Faculty of Medicine, 35100 Izmir, Türkiye. |
| 期刊 | Cancers |
| SCI 分区 | Q2 |
| IF | 5.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景/目的： 局部晚期喉鳞状细胞癌的治疗仍存在争议。本研究比较了根治性放化疗（CRT）与全喉切除术后辅助放疗伴或不伴化疗（TL + PORT/CRT）在T3-T4aN0-N1期疾病中的疗效。方法：这项多中心回顾性队列研究纳入2008年至2025年间在两个中心接受治疗的311例患者：160例接受根治性CRT，151例接受TL + PORT/CRT。采用Kaplan-Meier法和Cox回归分析估计生存率。倾向性评分匹配（PSM）和逆概率治疗加权（IPTW）用于校正分析。主要终点为疾病特异性生存期（DSS）。结果：中位随访时间为98个月。在未匹配队列中，CRT后5年和10年DSS率分别为92.1%和92.1%，而TL + PORT/CRT后分别为93.7%和83.5%（p = 0.351），但5年局部控制率以TL + PORT/CRT更优（98% vs. 79%；p < 0.001）。PSM后（每组59例患者），聚类稳健Cox分析显示CRT后总生存期（OS）更差（风险比[HR]，2.08；95%置信区间[CI]，1.12-3.86；p = 0.021），局部控制也更差（HR，12.83；95% CI，3.75-43.87；p < 0.001）。在2015-2025年调强放疗（IMRT）限制分析中，OS也以TL + PORT/CRT更优（HR，3.64；95% CI，1.09-12.22；p = 0.036），而全队列IPTW显示OS无显著差异（HR，0.93；95% CI，0.64-1.36；p = 0.715）。CRT后126/160例患者（78.8%）实现了功能性喉保留。结论：根治性CRT与局部控制较差相关，而DSS仍相当。OS估计在不同校正分析中有所差异，未支持稳定的治疗特异性生存效应。对于适当选择的患者，根治性CRT仍是一种器官保留选择。
英文摘要
Background/Objectives: Management of locally advanced laryngeal squamous cell carcinoma remains controversial. This study compared definitive chemoradiotherapy (CRT) with total laryngectomy followed by postoperative radiotherapy with or without chemotherapy (TL + PORT/CRT) in T3-T4aN0-N1 disease. Methods: This multicenter retrospective cohort included 311 patients treated between 2008 and 2025 at two centers: 160 received definitive CRT and 151 underwent TL + PORT/CRT. Survival was estimated using Kaplan-Meier and Cox regression analyses. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used as adjusted analyses. The primary endpoint was disease-specific survival (DSS). Results: Median follow-up was 98 months. In the unmatched cohort, 5- and 10-year DSS rates were 92.1% and 92.1% after CRT versus 93.7% and 83.5% after TL + PORT/CRT (p = 0.351), while 5-year local control favored TL + PORT/CRT (98% vs. 79%; p < 0.001). After PSM (59 patients per group), cluster-robust Cox analysis showed inferior overall survival (OS) after CRT (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.12-3.86; p = 0.021) and inferior local control (HR, 12.83; 95% CI, 3.75-43.87; p < 0.001). In the 2015-2025 intensity-modulated radiotherapy (IMRT)-restricted analysis, OS also favored TL + PORT/CRT (HR, 3.64; 95% CI, 1.09-12.22; p = 0.036), whereas full-cohort IPTW showed no significant OS difference (HR, 0.93; 95% CI, 0.64-1.36; p = 0.715). Functional laryngeal preservation was achieved in 126/160 patients (78.8%) after CRT. Conclusions: Definitive CRT was associated with inferior local control, while DSS remained comparable. OS estimates varied across adjusted analyses and did not support a stable treatment-specific survival effect. Definitive CRT remains an organ-preservation option in appropriately selected patients.