Prognostic significance of adjuvant therapy and specific radiation dosages in Taiwanese patients with oral cavity cancer and extra-nodal extension: a nationwide cohort study.

Humans Male Female Mouth Neoplasms / therapy Taiwan / epidemiology Middle Aged Retrospective Studies Prognosis Aged Chemoradiotherapy, Adjuvant / methods Radiotherapy Dosage Adult Extranodal Extension Squamous Cell Carcinoma of Head and Neck / therapy
Cancer registry Chemoradiotherapy Extra-nodal extension Oral cavity squamous cell carcinoma Radiotherapy Survival outcomes

Journal

BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800

Informations de publication

Date de publication:
25 Oct 2024
Historique:
received: 28 06 2024
accepted: 08 10 2024
medline: 26 10 2024
pubmed: 26 10 2024
entrez: 25 10 2024
Statut: epublish

Résumé

The evidence for adjuvant chemoradiotherapy (CRT) of oral cavity squamous cell carcinoma (OCSCC) with extra-nodal extension (ENE) in National Comprehensive Cancer Network (NCCN) guidelines is derived from patients with head and neck cancer. The guidelines further suggest a radiation dose ranging from 6000 to 6600 cGy. In this nationwide study, we sought to evaluate the prognostic significance of adjuvant therapy and the specific radiation dosage in Taiwanese patients with pure OCSCC and ENE. A retrospective analysis of 1577 OCSCC patients with ENE who underwent resection and received adjuvant CRT or radiotherapy (RT) between January 2011 and December 2020 was conducted. Multivariable analysis revealed that adjuvant RT, more than four pathologically positive nodes, and radiation dosage below 6000 cGy were independent risk factors for unfavorable 5-year disease-specific survival (DSS) and overall survival (OS). Comparing patients who received CRT (n = 1453) to those treated with RT (n = 124) before and after propensity score (PS) matching, the 5-year outcomes were as follows: before PS matching, DSS (54% versus 30%, p < 0.0001), OS (42% versus 18%, p < 0.0001); after PS matching (n = 111 in each group), DSS (52% versus 30%, p = 0.0016), OS (38% versus 21%, p = 0.0019). For patients who underwent CRT, the 5-year outcomes for different radiation dose groups (6600 - 7000 cGy, n = 1155 versus 6000 - 6500 cGy, n = 199) were as follows: before PS matching, DSS (52% versus 54%, p = 0.1904), OS (43% versus 46%, p = 0.1610); after PS matching (n = 199 in each group), DSS (55% versus 54%, p = 0.8374), OS (46.5% versus 46.3%, p = 0.7578). For OCSCC patients with ENE, our study shows CRT improved survivals than RT alone, underscoring the clinical significance of chemotherapy. Patients undergoing CRT with irradiation doses ranging from 6000 to 6500 cGy exhibited comparable survival outcomes to those receiving doses of 6600-7000 cGy. This observation suggests that irradiation doses exceeding the 6600 cGy may not confer the survival advantage in these patients. Further research is needed to confirm our results and explore the optimal irradiation dose for managing these patients.

Sections du résumé

BACKGROUND BACKGROUND
The evidence for adjuvant chemoradiotherapy (CRT) of oral cavity squamous cell carcinoma (OCSCC) with extra-nodal extension (ENE) in National Comprehensive Cancer Network (NCCN) guidelines is derived from patients with head and neck cancer. The guidelines further suggest a radiation dose ranging from 6000 to 6600 cGy. In this nationwide study, we sought to evaluate the prognostic significance of adjuvant therapy and the specific radiation dosage in Taiwanese patients with pure OCSCC and ENE.
METHODS METHODS
A retrospective analysis of 1577 OCSCC patients with ENE who underwent resection and received adjuvant CRT or radiotherapy (RT) between January 2011 and December 2020 was conducted.
RESULTS RESULTS
Multivariable analysis revealed that adjuvant RT, more than four pathologically positive nodes, and radiation dosage below 6000 cGy were independent risk factors for unfavorable 5-year disease-specific survival (DSS) and overall survival (OS). Comparing patients who received CRT (n = 1453) to those treated with RT (n = 124) before and after propensity score (PS) matching, the 5-year outcomes were as follows: before PS matching, DSS (54% versus 30%, p < 0.0001), OS (42% versus 18%, p < 0.0001); after PS matching (n = 111 in each group), DSS (52% versus 30%, p = 0.0016), OS (38% versus 21%, p = 0.0019). For patients who underwent CRT, the 5-year outcomes for different radiation dose groups (6600 - 7000 cGy, n = 1155 versus 6000 - 6500 cGy, n = 199) were as follows: before PS matching, DSS (52% versus 54%, p = 0.1904), OS (43% versus 46%, p = 0.1610); after PS matching (n = 199 in each group), DSS (55% versus 54%, p = 0.8374), OS (46.5% versus 46.3%, p = 0.7578).
CONCLUSIONS CONCLUSIONS
For OCSCC patients with ENE, our study shows CRT improved survivals than RT alone, underscoring the clinical significance of chemotherapy. Patients undergoing CRT with irradiation doses ranging from 6000 to 6500 cGy exhibited comparable survival outcomes to those receiving doses of 6600-7000 cGy. This observation suggests that irradiation doses exceeding the 6600 cGy may not confer the survival advantage in these patients. Further research is needed to confirm our results and explore the optimal irradiation dose for managing these patients.

Identifiants

DOI: 10.1186/s12885-024-13048-1 PMID: 39456017
pubmed: 39456017
doi: 10.1186/s12885-024-13048-1
pii: 10.1186/s12885-024-13048-1
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1320

Subventions

Organisme : Chang Gung Memorial Hospital, Linkou
ID : CMRPD1H0521

Informations de copyright

© 2024. The Author(s).

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Auteurs

Yao-Te Tsai (YT)

Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.

Wen-Cheng Chen (WC)

Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi and Chang Gung University, Taoyuan, Taiwan, ROC.

Yu-Wen Wen (YW)

Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan, ROC.
Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.

Chien-Yu Lin (CY)

Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Kang-Hsing Fan (KH)

Department of Radiation Oncology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, ROC.

Jin-Ching Lin (JC)

Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan, ROC.

Shu-Hang Ng (SH)

Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Shu-Ru Lee (SR)

Research Service Center for Health Information, Chang Gung University, Taoyuan Taiwan, ROC.

Chung-Jan Kang (CJ)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Li-Yu Lee (LY)

Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Chih-Yen Chien (CY)

Doctoral Program of Clinical and Experimental Medicine, Kaohsiung Chang Gung Memorial Hospital, National Sun Yat-sen University, Taiwan, ROC.

Chun-Hung Hua (CH)

Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, ROC.

Cheng Ping Wang (CP)

Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC.

Tsung-Ming Chen (TM)

Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC.

Shyuang-Der Terng (SD)

Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, ROC.

Chi-Ying Tsai (CY)

Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Hung-Ming Wang (HM)

Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Chia-Hsun Hsieh (CH)

Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Chih-Hua Yeh (CH)

Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Chih-Hung Lin (CH)

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.

Chung-Kan Tsao (CK)

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.

Nai-Ming Cheng (NM)

Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Tuan-Jen Fang (TJ)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Shiang-Fu Huang (SF)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Li-Ang Lee (LA)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Ku-Hao Fang (KH)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Yu-Chien Wang (YC)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Wan-Ni Lin (WN)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Li-Jen Hsin (LJ)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Tzu-Chen Yen (TC)

Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.

Chun-Ta Liao (CT)

Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC. liaoct@cgmh.org.tw.
Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Linkou, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan. liaoct@cgmh.org.tw.

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questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Prognostic significance of adjuvant therapy...
questionsmedicales.fr › Maladies du système stomatognathique › Maladies de la bouche › Tumeurs de la bouche › Prognostic significance of adjuvant therapy...
questionsmedicales.fr › Régions géographiques › Iles › Taïwan › Prognostic significance of adjuvant therapy...
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questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Prognostic significance of adjuvant therapy...
questionsmedicales.fr › Diagnostic › Pronostic › Prognostic significance of adjuvant therapy...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Prognostic significance of adjuvant therapy...
questionsmedicales.fr › Thérapeutique › Radiothérapie › Chimioradiothérapie › Chimioradiothérapie adjuvante › Prognostic significance of adjuvant therapy...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Métastase tumorale › Extension extranodale › Prognostic significance of adjuvant therapy...
questionsmedicales.fr › Tumeurs › Tumeurs par siège › Tumeurs de la tête et du cou › Carcinome épidermoïde de la tête et du cou › Prognostic significance of adjuvant therapy...