鼻咽癌放疗后孤立区域失败的手术治疗：选择性或根治性颈淋巴结清扫术
Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection.
作者信息
Liu You-Ping, Li Hao, You Rui, Li Ji-Bin, Liu Xue-Kui, Yang An-Kui, Guo Xiang, Song Ming, Zhang Quan, Guo Zhu-Ming, Chen Wen-Kuan, Liu Wei-Wei, Zou Xiong, Hua Yi-Jun, Yang Qi, Zhang Yi-Nuan, Sun Rui, Mo Hao-Yuan, Guo Ling, Lin Ai-Hua, Mai Hai-Qiang, Qian Chao-Nan, Chen Ming-Yuan
机构信息
Department of Nasopharyngeal Carcinoma, Guangzhou, People's Republic of China.
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.
出版信息
Laryngoscope. 2019 Feb;129(2):387-395. doi: 10.1002/lary.27317. Epub 2018 Oct 16.
OBJECTIVE
To compare survival effects of comprehensive neck dissection (CND) and selective neck dissection (SND) for patients with nasopharyngeal carcinoma (NPC) with only regional failure.
METHODS
A total of 294 recurrent T0N1-3M0 NPC patients who underwent neck dissection in Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China, between January 1984 and February 2014, were enrolled in the survival and interaction analyses. Using propensity scores to adjust for potential prognostic factors, an additional well-balanced cohort of 210 patients was constructed by matching each patient who received SND with one patient who underwent CND (1:1); the differences were then compared between SND and CND in terms of overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS).
RESULTS
Both univariate and multivariate analyses showed that SND was not inferior to CND (P > 0.05) but demonstrated that extracapsular spread (ECS) (hazard ratio [HR] 3.49, 95% confidence interval [CI] 2.30-5.29, P < 0.001), recurrent N stage (rN stage) (HR 1.96, 95% CI 1.29-2.97, P = 0.002), and positive margins (HR 3.67, 95% CI 2.40-5.62, P < 0.001) were independent poor prognostic factors for OS. The interaction effects between the dissection style and each independent factor were not significant for OS, LRFS, RRFS, or DMFS (P > 0.05). Furthermore, no survival differences were found between SND and CND in the case-matched cohort in terms of OS, LRFS, RRFS, or DMFS (P = 0.550, 0.930, 0.214, and 0.146, respectively).
CONCLUSION
With a similar radical dissection extent around the tumor rather than dissection of extensive lymph region distal to the lesion, SND is not inferior to CND for patients with NPC with only cervical failure. ECS, rN stage, and positive margins were adverse independent prognostic factors for patients with NPC.
LEVEL OF EVIDENCE
4 Laryngoscope, 129:387-395, 2019.
目的
比较根治性颈清扫术（CND）与选择性颈清扫术（SND）对仅出现区域复发的鼻咽癌（NPC）患者的生存效果。
方法
选取1984年1月至2014年2月间在中华人民共和国广州中山大学肿瘤防治中心接受颈清扫术的294例复发T0N1 - 3M0鼻咽癌患者进行生存及交互分析。利用倾向评分调整潜在预后因素，通过将每例接受SND的患者与1例接受CND的患者进行匹配（1:1）构建了一个包含210例患者的平衡良好的队列；然后比较SND与CND在总生存期（OS）、无局部复发生存期（LRFS）、无区域复发生存期（RRFS）和无远处转移生存期（DMFS）方面的差异。
结果
单因素和多因素分析均显示SND不劣于CND（P > 0.05），但表明包膜外扩散（ECS）（风险比[HR] 3.49，95%置信区间[CI] 2.30 - 5.29，P < 0.001）、复发N分期（rN分期）（HR 1.96，95% CI 1.29 - 2.97，P = 0.002）和切缘阳性（HR 3.67，95% CI 2.40 - 5.62，P < 0.001）是OS的独立不良预后因素。清扫方式与各独立因素之间在OS、LRFS、RRFS或DMFS方面的交互作用不显著（P > 0.05）。此外，在病例匹配队列中，SND与CND在OS、LRFS、RRFS或DMFS方面未发现生存差异（P分别为0.550、0.930、0.214和0.146）。
结论
对于仅颈部复发的鼻咽癌患者，SND在肿瘤周围的根治性清扫范围相似而非清扫病变远端广泛淋巴区域的情况下，不劣于CND。ECS、rN分期和切缘阳性是鼻咽癌患者不良的独立预后因素。
证据水平
4 喉镜，129:387 - 395，2019年。
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