Krol B J, Righi P D, Weisberger E C, Smith R M, Wynne M
Department of Otolaryngology--Head and Neck Surgery, Indiana UniversityMedical Center, Indianapolis, IN, USA.
Am J Otolaryngol. 2000 Nov-Dec;21(6):360-5. doi: 10.1053/ajot.2000.18871.
Our study goal was to identify clinical factors associated with, and that might predict, treatment outcome for patients with an isolated cervical recurrence of squamous cell carcinoma in the previously treated neck (ICR-PTN).
We reviewed all patients with noncutaneous head and neck squamous cell carcinoma treated at our tertiary care center between 1987 and 1997, and identified 17 patients (2%) who later developed an isolated recurrence in a previously treated neck. These patients made up our study group, and their charts were thoroughly reviewed. Outcome of salvage therapy (surgery, radiation, or combined therapy) for these patients was compared with pooled clinicopathologic data using the Fisher exact test (one tail).
Fifteen such ICR-PTN patients consented to salvage therapy. Six patients were without disease at last follow-up, and 3 were successfully palliated. A statistically significant association between the side of ICR-PTN relative to the primary tumor and outcome of salvage therapy (P =.026) was noted, with ipsilateral neck recurrence being a favorable prognostic factor. Trends that did not meet the standard for statistical significance were observed between a better outcome of salvage therapy and the following parameters: age of less than 60, nonsurgical initial treatment of the neck, and lack of a history of a recurrence before they developed the ICR-PTN.
The current study showed that only the side of the ICR-PTN relative to the primary site is associated with outcome of salvage therapy. Based on our findings and a review of the literature, we have developed a summary of factors that might predict which patients with an ICR-PTN are most likely to benefit from aggressive salvage therapy.
我们的研究目标是确定与先前接受治疗的颈部孤立性宫颈鳞状细胞癌复发（ICR-PTN）患者的治疗结果相关且可能预测该结果的临床因素。
我们回顾了1987年至1997年间在我们三级医疗中心接受治疗的所有非皮肤性头颈部鳞状细胞癌患者，并确定了17例（2%）后来在先前接受治疗的颈部出现孤立性复发的患者。这些患者组成了我们的研究组，并对他们的病历进行了全面回顾。使用Fisher精确检验（单尾）将这些患者的挽救治疗（手术、放疗或联合治疗）结果与汇总的临床病理数据进行比较。
15例此类ICR-PTN患者同意接受挽救治疗。6例患者在最后一次随访时无疾病，3例患者成功缓解。注意到ICR-PTN相对于原发肿瘤的侧别与挽救治疗结果之间存在统计学显著关联（P = 0.026），同侧颈部复发是一个有利的预后因素。在挽救治疗效果较好与以下参数之间观察到未达到统计学显著性标准的趋势：年龄小于60岁、颈部非手术初始治疗以及在发生ICR-PTN之前无复发史。
当前研究表明，只有ICR-PTN相对于原发部位的侧别与挽救治疗结果相关。基于我们的研究结果和文献回顾，我们总结了可能预测哪些ICR-PTN患者最有可能从积极的挽救治疗中获益的因素。
