Tam Samantha, Araslanova Rakhna, Low Tsu-Hui Hubert, Warner Andrew, Yoo John, Fung Kevin, MacNeil S Danielle, Palma David A, Nichols Anthony C
Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada.
Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
JAMA Otolaryngol Head Neck Surg. 2017 Jul 1;143(7):685-690. doi: 10.1001/jamaoto.2017.0001.
Locoregional recurrence of oral cavity squamous cell carcinoma (OCSCC) continues to be a life-threatening and difficult clinical situation. Salvage surgery can result in significant morbidities, and survival following recurrence is poor.
To outline prognostic factors influencing overall survival (OS) following salvage surgery for OCSCC to guide management of treatment for patients with locoregionally recurrent disease.
DESIGN, SETTING, AND PARTICIPANTS: The medical records of 293 patients presenting to the London Health Sciences Center with locoregionally recurrent OCSCC between October 5, 1999, and May 2, 2011, were retrospectively reviewed. The primary outcome was OS from salvage treatment to last follow-up or death. Univariate analyses were carried out using the Cox proportional hazards regression model. A recursive partitioning analysis was used to create risk groups based on prognosis. Analysis was conducted from December 8, 2015, to February 26, 2016.
Of the 293 patients evaluated, 59 (20%) had recurrence identified after their initial OCSCC treatment; 39 (66%) were men, and the mean (SD) age at diagnosis was 62.2 (11.8) years. Thirty-nine (66%) of these patients underwent salvage surgery for locoregional recurrence with curative intent. Five-year OS from the time of salvage surgery was 43%. Recursive partitioning analysis identified 3 risk groups: (1) high risk (patients who received adjuvant chemoradiotherapy or radiotherapy after initial surgery) with 5-year OS rate of 10% (hazard ratio [HR], 9.41; 95% CI, 2.68-33.04), (2) intermediate risk (previous surgery alone, age ≥62 years) with a 5-year OS rate of 39% (HR, 2.95; 95% CI, 0.86-10.09), and (3) low risk (previous surgery alone, age <62 years) with 5-year OS rate of 74%.
This recursive partitioning analysis identified 3 prognostic groups in patients undergoing salvage surgery for recurrent OCSCC. The marked differences in survival between these groups should be taken into consideration when counselling and managing treatment for patients with locoregionally recurrent disease.
口腔鳞状细胞癌（OCSCC）的局部区域复发仍然是一种危及生命且临床处理困难的情况。挽救性手术可能导致严重的并发症，且复发后的生存率很低。
概述影响OCSCC挽救性手术后总生存期（OS）的预后因素，以指导局部区域复发性疾病患者的治疗管理。
设计、背景和参与者：对1999年10月5日至2011年5月2日期间在伦敦健康科学中心就诊的293例局部区域复发性OCSCC患者的病历进行回顾性分析。主要结局是从挽救性治疗至最后一次随访或死亡的OS。使用Cox比例风险回归模型进行单因素分析。采用递归划分分析根据预后创建风险组。分析于2015年12月8日至2016年2月26日进行。
在评估的293例患者中，59例（20%）在初次OCSCC治疗后出现复发；39例（66%）为男性，诊断时的平均（标准差）年龄为62.2（11.8）岁。其中39例（66%）患者因局部区域复发接受了根治性挽救性手术。从挽救性手术时起的5年OS率为43%。递归划分分析确定了3个风险组：（1）高风险组（初次手术后接受辅助放化疗或放疗的患者），5年OS率为10%（风险比[HR]，9.41；95%置信区间[CI]，2.68 - 33.04），（2）中风险组（仅接受过先前手术，年龄≥62岁），5年OS率为39%（HR，2.95；95% CI，0.86 - 10.09），（3）低风险组（仅接受过先前手术，年龄<62岁），5年OS率为74%。
该递归划分分析确定了复发性OCSCC挽救性手术患者的3个预后组。在为局部区域复发性疾病患者提供咨询和管理治疗时，应考虑这些组之间显著的生存差异。
