晚期扁桃体鳞状细胞癌手术治疗与非手术治疗的疗效比较

Effect evaluation of surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced tonsillar squamous cell carcinoma

目的应用倾向评分匹配方法,比较晚期扁桃体鳞状细胞癌(鳞癌)手术治疗与非手术治疗的疗效。方法回顾性分析2000年12月至2018年12月在北京协和医院诊治的经病理证实、无远处转移的324例晚期扁桃体鳞癌患者的临床资料,男301例,女23例,年龄28~76(58.5±11.4)岁。324例患者中,采用非手术治疗患者102例,手术治疗患者222例。采用Kaplan-Meier、多因素Cox回归分析和倾向评分匹配方法进行生存分析,比较2组患者的疾病特异性生存率(disease-specific survival,DSS)、无病生存率(disease-free survival,DFS)和总生存率(overall survival,OS)。结果Cox多因素分析显示非手术治疗组较手术治疗组患者存在预后优势,但2组间差异无统计学意义[OS:校正风险比(adjusted Hazard Ratio,aHR)为0.92,95%置信区间(CI)为0.60~1.42;DSS:aHR为0.71,95%CI为0.43~1.20;DFS:aHR为0.82,95%CI为0.53~1.28]。经倾向评分匹配后,非手术治疗组与手术治疗组各有102例,2组间的生存率差异无统计学意义(OS:aHR为0.85,95%CI为0.51~1.40;DSS:aHR为0.62,95%CI为0.35~1.11;DFS:aHR为0.80,95%CI为0.49~1.33)。结论非手术治疗与手术治疗对于晚期扁桃体鳞癌患者预后无明显差异,而非手术治疗有利于提高患者生活质量。

Objective Using propensity score matching method(PSM)to investigate the clinical effect of surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced tonsillar squamous cell carcinoma.Methods A retrospective analysis was conducted on the clinical data of 324 patients diagnosed with advanced tonsillar squamous cell carcinoma and treated in Peking Union Medical College Hospital from 2000 to 2018,confirmed by pathology and without distant metastasis.Survival analysis was performed using Kaplan-Meier estimates,the Cox proportional hazards model,and propensity score matching(PSM).Results Of the 324 patients,102 were treated with non-surgery chemoradiotherapy treatment strategies and 222 with surgical plus radio(chemo)therapy treatment.Cox multivariate analysis showed that the non-surgery treatment group had a favorable prognosis than the surgical treatment group,however,these outcomes were not significantly different[overall survival(OS):adjusted Hazard Ratios(aHR):0.92,95%confidence interval(CI):0.60-1.42;disease-specific survival(DSS):aHR:0.71,95%CI:0.43-1.20;disease-free survival(DFS):aHR:0.82,95%CI:0.53-1.28].The new patient cohort consisted of 102 subpairs after PSM.There were no significant differences between two groups(OS:aHR:0.85,95%CI:0.51-1.40;DSS:aHR:0.62,95%CI:0.35-1.11;DFS:aHR:0.80,95%CI:0.49-1.33).Conclusion Our findings indicate that patients with non-surgical treatment do not have significantly better survival outcomes compared to surgical treatment group,while non-surgical treatment has advantages in improving the quality of life of patients,so comprehensive treatment based on radiotherapy and chemotherapy may be recommended for advanced tonsillar squamous cell carcinoma.