头颈癌肿瘤分布、治疗模式及生存率的部位特异性趋势：SEER数据库分析

文献信息

中文摘要

引言： 随着器官保留方案的引入和疾病病因学的变化，头颈癌（HNC）的管理已发生显著演变。
目的： 利用监测、流行病学和最终结果（SEER）项目，分析肿瘤分布、分期、治疗方式和生存结局的部位特异性趋势。
方法： 对SEER项目（2000-2021年）中288,132例恶性HNC病例进行回顾性分析。生存分析仅限于2000年至2015年间诊断的病例，以保证足够的随访时间。解剖部位包括唾液腺、喉、口腔、唇、舌、鼻咽、口咽和下咽。采用线性回归评估肿瘤构成比、临床分期和治疗方式的趋势。采用多因素logistic回归分析5年生存趋势。
结果： 舌癌诊断比例增加12.2%（p < 0.001），而喉癌比例下降10.0%（p < 0.001）。治疗模式发生显著变化，手术联合放疗（-11.0%；p < 0.001）和单纯放疗（-7.6%；p < 0.001）的比例下降，而放化疗比例上升（+16.9%；p < 0.001）。下咽癌（8.5%；p < 0.001）、舌癌（8.5%；p < 0.001）和口咽癌（8.0%；p < 0.01）的5年生存率有所改善。
结论： HNC的管理已转向包括化疗在内的多模式治疗，同时咽部和口腔亚部位的生存率有所改善。舌癌和口咽癌病例比例上升可能反映了潜在病因因素的变化，包括人乳头瘤病毒（HPV）相关疾病，尽管SEER项目无法直接评估HPV特异性效应。

英文摘要

INTRODUCTION: Head and neck cancer (HNC) management has evolved significantly with the introduction of organ-preservation protocols and changing disease etiology.
OBJECTIVE: To analyze site-specific trends in tumor distribution, staging, treatment modality, and survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) program.
METHODS: A retrospective analysis of 288,132 malignant HNC cases from the SEER program (2000-2021) was performed. Survival analyses were restricted to cases diagnosed between 2000 and 2015 to allow for adequate follow-up. The anatomical sites included the salivary gland, larynx, the oral cavity, the lip, the tongue, the nasopharynx, the oropharynx, and the hypopharynx. Trends in tumor proportion, clinical stage, and treatment modality were assessed using linear regression. Five-year survival trends were analyzed using multivariate logistic regression.
RESULTS: The proportion of tongue-cancer diagnoses increased by 12.2% ( p  < 0.001), while that of laryngeal cancer decreased by 10.0% ( p  < 0.001). Treatment patterns shifted significantly, with the rates of surgery combined with radiation (-11.0%; p  < 0.001) and radiation alone (-7.6%; p  < 0.001) declining, while that of chemoradiation increased (+16.9%; p  < 0.001). The 5-year survival rates improved for hypopharynx (8.5%; p  < 0.001), tongue (8.5%; p  < 0.001), and oropharynx (8.0%; p  < 0.01) cancers.
CONCLUSION: The management of HNC has shifted toward multimodal therapies involving chemotherapy, coinciding with improved survival in pharyngeal and oral subsites. The rising proportion of tongue and oropharyngeal cases may reflect changes in underlying etiologic factors, including human papillomavirus (HPV)-associated disease, although HPV-specific effects cannot be directly assessed in the SEER program.