Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale · 2026
Surgery Versus Radiotherapy in Older Adults with Oral Cavity Cancer: A Nationwide Comparative Effectiveness Study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Lin Kuan-Chou, Chang Chia-Lun, Chen Wan-Ming, Shia Ben-Chang, Wu Szu-Yuan, Fang Chih-Yuan
Аннотация
IMPORTANCE: Older adults with oral cavity squamous cell carcinoma (OCSCC) are underrepresented in clinical trials, and the comparative effectiveness of surgery versus definitive radiotherapy with or without chemotherapy (RT ± CT) remains uncertain.
OBJECTIVE: To compare all-cause and OCSCC-specific mortality after curative-intent surgery versus definitive RT ± CT in older adults with newly diagnosed OCSCC.
DESIGN: Nationwide, population-based retrospective cohort study using linked registry and claims data. Propensity score fine stratification weighting (PS-FSW) and multivariable Cox proportional hazards models were used to reduce treatment selection bias.
SETTING: Taiwan Cancer Registry, National Health Insurance Research Database, and Taiwan Death Registry.
PARTICIPANTS: Patients aged ≥65 years with newly diagnosed, nonmetastatic, pathologically confirmed OCSCC between January 1, 2009, and December 31, 2022.Intervention or Exposures:Curative-intent surgery, with or without adjuvant therapy, compared with definitive RT ± CT delivered with curative-intent.
MAIN OUTCOME MEASURES: All-cause mortality and OCSCC-specific mortality.
RESULTS: Among 1275 eligible patients, 492 underwent curative-intent surgery and 783 received definitive RT ± CT. After PS-FSW, baseline characteristics were well balanced. Surgery was associated with lower all-cause mortality (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.51, 0.69; P < .0001) and lower OCSCC-specific mortality (aHR 0.63; 95% CI 0.51, 0.78; P < .0001) compared with definitive RT ± CT. The survival benefit persisted across age strata, including patients aged ≥85 years.
CONCLUSIONS: Curative-intent surgery was associated with superior all-cause and cancer-specific survival compared with definitive RT ± CT among older adults with OCSCC.
RELEVANCE: Chronological age alone should not preclude surgical consideration in older adults with OCSCC. Treatment decisions should incorporate physiologic fitness, comorbidity burden, geriatric assessment, and multidisciplinary evaluation; future studies should further evaluate treatment-related toxicity, functional outcomes, and quality-of-life.
OBJECTIVE: To compare all-cause and OCSCC-specific mortality after curative-intent surgery versus definitive RT ± CT in older adults with newly diagnosed OCSCC.
DESIGN: Nationwide, population-based retrospective cohort study using linked registry and claims data. Propensity score fine stratification weighting (PS-FSW) and multivariable Cox proportional hazards models were used to reduce treatment selection bias.
SETTING: Taiwan Cancer Registry, National Health Insurance Research Database, and Taiwan Death Registry.
PARTICIPANTS: Patients aged ≥65 years with newly diagnosed, nonmetastatic, pathologically confirmed OCSCC between January 1, 2009, and December 31, 2022.Intervention or Exposures:Curative-intent surgery, with or without adjuvant therapy, compared with definitive RT ± CT delivered with curative-intent.
MAIN OUTCOME MEASURES: All-cause mortality and OCSCC-specific mortality.
RESULTS: Among 1275 eligible patients, 492 underwent curative-intent surgery and 783 received definitive RT ± CT. After PS-FSW, baseline characteristics were well balanced. Surgery was associated with lower all-cause mortality (adjusted hazard ratio [aHR] 0.59; 95% confidence interval [CI] 0.51, 0.69; P < .0001) and lower OCSCC-specific mortality (aHR 0.63; 95% CI 0.51, 0.78; P < .0001) compared with definitive RT ± CT. The survival benefit persisted across age strata, including patients aged ≥85 years.
CONCLUSIONS: Curative-intent surgery was associated with superior all-cause and cancer-specific survival compared with definitive RT ± CT among older adults with OCSCC.
RELEVANCE: Chronological age alone should not preclude surgical consideration in older adults with OCSCC. Treatment decisions should incorporate physiologic fitness, comorbidity burden, geriatric assessment, and multidisciplinary evaluation; future studies should further evaluate treatment-related toxicity, functional outcomes, and quality-of-life.