Matoscevic Katja, Graf Nicole, Pezier Thomas F, Huber Gerhard F
Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
Graf Biostatistics, Winterthur, Switzerland.
Otolaryngol Head Neck Surg. 2014 Sep;151(3):454-61. doi: 10.1177/0194599814535183. Epub 2014 Jun 3.
Despite advances in interdisciplinary treatment protocols, the chance of cure for recurrent head and neck squamous cell carcinoma (HNSCC) following failed primary therapy is poor and often entails a high morbidity. Recurrence rates vary widely in the literature depending on tumor localization, primary tumor stage, and treatment modality, and only a minority of patients can be salvaged.
Historical cohort study.
This study valuates the outcomes of patients treated for recurrent squamous cell carcinoma of the larynx, pharynx, and oral cavity in the largest tertiary referral center of Switzerland to find predictors for survival in salvage surgery with curative intent.
Included were 176 consecutive patients with recurrent disease after primary curative treatment of HNSCC, in locations mentioned previously. Kaplan-Meier survival analyses with log-rank testing were performed depending on T and N stage, gender, treatment, and location of first relapse to evaluate the impact on overall survival, disease specific survival, and recurrence free survival.
Overall successful salvage rates were 49.2% for laryngeal recurrence, 35.1% for oral cavity, 32.7% for oropharyngeal, and a mere 17.4% for hypopharyngeal recurrences. Predictive factors for better outcome were location of recurrence, female gender, lymph node status, and extent of salvage treatment.
In case of recurrent disease, laryngeal cancers showed the best salvage rates, whereas in hypopharyngeal relapses, very few patients could be successfully salvaged. Patients therefore should be carefully selected and counseled for salvage treatment according to patient motivation, age, type of previous treatment, surgical resectability, and exclusion of distant recurrence.
尽管跨学科治疗方案取得了进展，但原发性治疗失败后复发的头颈部鳞状细胞癌（HNSCC）的治愈机会渺茫，且往往伴随着较高的发病率。根据肿瘤定位、原发性肿瘤分期和治疗方式的不同，文献中的复发率差异很大，只有少数患者能够得到挽救。
历史队列研究。
本研究评估了在瑞士最大的三级转诊中心接受喉、咽和口腔复发性鳞状细胞癌治疗的患者的预后情况，以寻找根治性挽救手术生存的预测因素。
纳入了176例先前接受过HNSCC根治性治疗后复发的患者，复发部位如前所述。根据T和N分期、性别、治疗方法以及首次复发部位进行Kaplan-Meier生存分析和对数秩检验，以评估对总生存、疾病特异性生存和无复发生存的影响。
喉复发的总体挽救成功率为49.2%，口腔为35.1%，口咽为32.7%，下咽复发仅为17.4%。预后较好的预测因素包括复发部位、女性性别、淋巴结状态和挽救治疗的范围。
对于复发性疾病，喉癌的挽救率最高，而下咽复发时，很少有患者能够成功挽救。因此，应根据患者的动机、年龄、既往治疗类型、手术可切除性以及排除远处复发等因素，仔细选择患者并为其提供挽救治疗的咨询。
