Sims John R, Van Abel Kathryn, Martin Eliot J, Lohse Christine M, Price Daniel L, Olsen Kerry D, Moore Eric J
1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
2 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Otolaryngol Head Neck Surg. 2017 Jul;157(1):69-76. doi: 10.1177/0194599817696304. Epub 2017 Apr 4.
Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery-based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days-6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery-based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.
目的 描述接受经口机器人手术治疗的人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）患者发生局部区域复发（LRR）或远处转移（DM）后的管理及肿瘤学结局。研究设计 病例系列研究并进行病历回顾。研究地点 三级医疗转诊中心。研究对象与方法 共有286例HPV阳性OPSCC患者在2007年5月至2015年5月期间接受了基于经口机器人手术的治疗。结果 286例患者中（12.2%），35例符合纳入标准。其中，19例发生LRR，16例发生DM；2例LRR患者随后发生DM。在LRR患者中，79%为T1/T2肿瘤，47%为N0/N1淋巴结疾病，而DM组分别为75%和6%。发生LRR或DM的中位时间分别为0.6年（四分位间距[IQR]，0.4 - 1.0）和1.8年（IQR，1.0 - 2.1）。23例患者（16例LRR，7例DM）尝试了根治性挽救治疗。接受挽救治疗后仍存活的18例患者从LRR或DM到最后一次随访的中位时间为1.9年（IQR，0.4 - 3.8；范围，7天 - 6.2年）。根治性治疗后3年的估计癌症特异性生存率在LRR组为63%（95%可信区间，39 - 100；仍处于风险中的人数，5），在DM组为100%（95%可信区间，100 - 100；仍处于风险中的人数，2）。结论 总体而言，基于经口机器人手术治疗的HPV阳性OPSCC发生LRR和DM的情况并不常见。在我们接受根治性治疗的患者亚组中，癌症特异性生存率良好。因此，对于合适的患者，应推荐对HPV阳性OPSCC的LRR和DM进行积极的挽救治疗。
