진행된 구인두암에서 수술 기반 치료의 효과

Abstract

Background and Objectives Oropharyngeal cancers (OPCs) can be staged down to a lowerstage with p16 positivity and de-escalated therapy has been the common practice. The aim ofthis study is to evaluate the survival outcomes based on various clinical factors in advancedOPC patients. Subjects and Method A total of 58 OPC patients in the stage IVA based on the AmericanJoint Committee on Cancer 7th edition were treated with primary surgery or primary chemoradiationtherapy from 2010 to 2016. A survival analysis was carried out using the Kaplan-Meier method, log-rank test, and Cox proportional hazards model. Results The median follow-up was 39.5 months. Thirty-eight and 20 patients received surgery-based and radiation therapy (RT)-based treatments, respectively. Clinical T-stage and treatmentmethod were significant risk factors for 5-year disease-free survival (DFS) rate, and thetreatment method was the only significant risk factor for overall-survival (OS) rate. 5-year DFSrate in the surgery-based treatment and RT-based treatment was 76.1% and 36.0% (p=0.001). On multivariate analysis, the surgery-based treatment group was associated with a significantlyreduced hazard of death [the hazard ratio (HR) for the radiation-based treatment was 6.565compared to the surgery-based treatment, p=0.002]. 5-year OS rate in the surgery-based treatmentand RT-based treatment was 91.1% and 53.4% (p=0.003), respectively. On the multivariateanalysis, the surgery-based treatment group was associated with a significantly reducedhazard of death (the HR for the radiation-based treatment was 7.544 compared to the surgerybasedtreatment, p=0.012). Conclusion The primary surgery-based treatment for advanced OPC showed a better survivaloutcome than the primary radiation-based treatment, irrespective of p16 positivity.