癌症患者行颞骨切除术的生存和复发预测因素。
Predictors of survival and recurrence after temporal bone resection for cancer.
机构信息
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
出版信息
Head Neck. 2012 Sep;34(9):1231-9. doi: 10.1002/hed.21883. Epub 2011 Sep 23.
BACKGROUND
The purpose of this study was to identify factors predictive of outcome in patients undergoing temporal bone resection (TBR) for head and neck cancer.
METHODS
This was a retrospective study of 72 patients undergoing TBR. Factors associated with survival and recurrence were identified on multivariable regression.
RESULTS
Most tumors were epithelial (81%), commonly (69%) involving critical structures. Cervical metastases were uncommon (6%). Squamous cell carcinoma (SCC) of the external auditory canal carried a high rate of parotid invasion (25%) and parotid nodal metastases (43%). The 5-year rate of overall survival (OS) was 62%; disease-specific survival (DSS), 70%; recurrence-free survival (RFS), 46%. Factors independently associated with outcome on multivariable analysis were margin status and extratemporal spread of disease to the parotid, mandible, or regional nodes. Recurrence was common (72%) in cT3-4 tumors.
CONCLUSIONS
Margin status and extratemporal disease spread are the strongest independent predictors of survival and recurrence. In SCC of the external auditory canal, high rates of parotid involvement support adjunctive parotidectomy. Risk of recurrence in T3-T4 tumors may support a role for adjuvant therapy.
背景
本研究旨在确定接受颞骨切除术（TBR）治疗头颈部癌症患者的预后相关因素。
方法
这是一项对 72 例接受 TBR 治疗的患者进行的回顾性研究。通过多变量回归确定与生存和复发相关的因素。
结果
大多数肿瘤为上皮性（81%），常累及关键结构（69%）。颈部转移不常见（6%）。外耳道鳞状细胞癌（SCC）有较高的腮腺侵犯率（25%）和腮腺淋巴结转移率（43%）。总生存率（OS）为 5 年 62%；疾病特异性生存率（DSS）为 70%；无复发生存率（RFS）为 46%。多变量分析中与预后相关的独立因素是切缘状态和颞外疾病向腮腺、下颌骨或区域淋巴结的扩散。cT3-4 肿瘤的复发率较高（72%）。
结论
切缘状态和颞外疾病扩散是生存和复发的最强独立预测因素。在外耳道 SCC 中，腮腺受累率高，支持辅助性腮腺切除术。T3-T4 肿瘤的复发风险可能支持辅助治疗的作用。
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