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SEER数据库14 805例扁桃体鳞癌患者预后关联因素及竞争风险分析

Analysis of prognostic factors and competing risks in 14, 805 cases with tonsil squamous cell carcinoma from the SEER database

    摘要
  • 摘要:
    目的 评估扁桃体鳞癌(TSCC)患者预后的关联因素, 分析TSCC患者死亡的竞争风险。
    方法 从SEER数据库获取1975—2020年扁桃体恶性肿瘤的病例资料，从中筛选出确诊为鳞状细胞癌的所有记录。采用Cox比例风险回归模型，探究性别、种族、年龄、婚姻状态、诊断年份、病变位置、病理证据、治疗方案与总体生存率及特定原因死亡结果之间的关系。评估不同临床特征的TSCC患者在特定原因死亡结局上的竞争风险。
    结果 本研究共纳入14 805例TSCC患者，其中男性11 650例，占比78.69%。93.99%的TSCC病例诊断于45岁以后, 45~64岁为TSCC的高发年龄段。相对于手术(49.47%)和化疗(47.10%), 放疗是应用最为广泛的治疗手段(81.78%)。截至随访终点, 8 003例(54.06%)TSCC患者死亡，中位生存期为2.33年。Cox比例风险回归分析结果显示，相较于接受手术、放疗、化疗的患者，未接受相应治疗因TSCC死亡患者的HR(95%CI)分别为2.101(1.972~2.239)、1.829(1.702~1.966)和1.023(0.951~1.100), 因其他原因死亡患者的HR(95%CI)分别为1.630(1.513~1.756)、1.438(1.318~1.570)和1.328(1.212~1.456)。与 < 45岁患者相比, ≥65岁因TSCC死亡患者的HR(95%CI)为2.218(1.933~2.545), 因其他原因死亡患者的HR(95%CI)为6.178(5.133~7.436)。
    结论 放疗、手术及化疗均有利于改善TSCC患者的预后。对于老年TSCC患者，应特别关注非TSCC相关的死亡风险。

     

    Abstract:
    Objective To evaluate factors associated with prognosis of tonsil squamous cell carcinoma (TSCC) patients and analyze the competing risks of death in TSCC patients.
    Methods Data tonsil malignant tumors cases diagnosed between 1975 and 2020 were obtained from the SEER database, and records confirmed as squamous cell carcinoma were selected. A Cox proportional hazards regression model was used to investigate the relationships of gender, race, age, marital status, year of diagnosis, lesion location, pathological evidence, treatment regimen with overall survival rate as well as cause-specific mortality outcomes. The competing risks of cause-specific death outcomes among TSCC patients with different clinical characteristics were assessed.
    Results This study included 14, 805 TSCC patients, including 11, 650 males, accounting for 78.69%. 93.99% of TSCC cases were diagnosed after the age of 45, with the highest incidence occurring in 45 to 64 age group. Radiotherapy was the most commonly used treatment modality (81.78%), compared to surgery (49.47%) and chemotherapy (47.10%). By the end of the follow-up period, 8, 003 (54.06%) TSCC patients had died, with a median survival time of 2.33 years. Cox proportional hazards regression analysis showed that the HR (95%CI) for TSCC-related deaths among patients not receiving surgery, radiotherapy and chemotherapy were 2.101 (1.972 to 2.239), 1.829 (1.702 to 1.966) and 1.023(0.951 to 1.100), respectively, compared to those who did receive these treatments; the HR (95%CI) for deaths due to other causes were 1.630 (1.513 to 1.756), 1.438 (1.318 to 1.570) and 1.328 (1.212 to 1.456), respectively. Compared to patients < 45 years old, the HR (95%CI) for TSCC-related deaths among patients ≥65 years old were 2.218 (1.933 to 2.545), and for deaths due to other causes were 6.178 (5.133 to 7.436).
    Conclusion Radiotherapy, surgery and chemotherapy all contribute to improving the prognosis of TSCC patients. For elderly TSCC patients, particular attention should be paid to non-TSCC-related death risks.

     

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