口咽癌的经口机器人手术：手术切缘与肿瘤学结局。

Transoral robotic surgery for oropharyngeal carcinoma: Surgical margins and oncologic outcomes.

作者信息

Moore Eric J, Van Abel Kathryn M, Price Daniel L, Lohse Christine M, Olsen Kerry D, Jackson Ryan S, Martin Eliot J

机构信息

Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota.

Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota.

出版信息

Head Neck. 2018 Apr;40(4):747-755. doi: 10.1002/hed.25055. Epub 2018 Jan 12.

DOI:10.1002/hed.25055

PMID:29327784

Abstract

BACKGROUND

This study presents oncologic outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal squamous cell carcinoma (SCC).

METHODS

Three hundred fourteen patients undergoing TORS ± adjuvant therapy for oropharyngeal SCC from May 1, 2007, to May 31, 2015, are analyzed.

RESULTS

Median follow-up was 3.3 years (interquartile range [IQR] 1.8-5.3 years; range 1 day to 9.3 years). Estimated locoregional recurrence-free survival, distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) rates (95% confidence interval [CI] number still at risk) at 5 years after surgery were 92% (88-95; 92), 90% (86-94; 92), 86% (82-92; 98), and 94% (91-97; 98), respectively. Negative margins were achieved in 98% of cases. The adult comorbidity evaluation (ACE)-27 comorbidity index, human papillomavirus (HPV) status, pathologic N classification, and number of attempts to clear margins were associated with death due to cancer (P = .003, P = .002, P = .030, and P = .002, respectively).

CONCLUSION

The need to take ≥2 margins to achieve resection portends an increased risk of locoregional recurrence and death due to disease in oropharyngeal SCC.

摘要

背景

本研究呈现了经口机器人手术（TORS）±辅助治疗口咽鳞状细胞癌（SCC）后的肿瘤学结局。

方法

分析了2007年5月1日至2015年5月31日期间接受TORS±辅助治疗的314例口咽SCC患者。

结果

中位随访时间为3.3年（四分位间距[IQR]为1.8 - 5.3年；范围为1天至9.3年）。术后5年时，估计的局部区域无复发生存率、远处转移无复发生存率（DMFS）、总生存率（OS）和癌症特异性生存率（CSS）（95%置信区间[CI]，仍处于风险中的病例数）分别为92%（88 - 95；92）、90%（86 - 94；92）、86%（82 - 92；98）和94%（91 - 97；98）。98%的病例实现了切缘阴性。成人合并症评估（ACE）-27合并症指数、人乳头瘤病毒（HPV）状态、病理N分类以及切缘阴性的尝试次数与癌症死亡相关（P分别为0.003、0.002、0.030和0.002）。