1 Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.
2 Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Otolaryngol Head Neck Surg. 2019 Jun;160(6):1023-1033. doi: 10.1177/0194599818818443. Epub 2018 Dec 11.
Most studies that report on salvage surgery after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) are small and heterogeneous. Subsequently, some relevant questions remain unanswered. We specifically focused on (1) difference in prognosis per tumor subsite, corrected for disease stage, and (2) differences in prognosis after salvage surgery for local, regional, and locoregional recurrences.
Retrospective analysis.
Single-center study (2000-2016).
Patients treated with salvage surgery for HNSCC recurrence after (chemo)radiotherapy.
In total, 189 patients were included. Five-year overall survival (OS) was 33%, and median OS was 18 (95% confidence interval [CI], 11-26) months. Treatment-related mortality was 2%. Larynx carcinoma was associated with more favorable local (adjusted hazard ratio [HR] = 4.02; 95% CI, 1.46-11.10; P = .007) and locoregional control (adjusted HR = 5.34; 95% CI, 1.83-15.61; P = .002) than pharyngeal carcinoma. American Society of Anesthesiologists (ASA) score (≥3 vs 1-2: adjusted HR = 3.04; 95% CI, 1.17-7.91; P = .023), pT stage (3-4 vs 1-2: adjusted HR = 4.41; 95% CI, 1.65-11.82; P = .003), and salvage surgery for locoregional recurrences (locoregional vs local: adjusted HR = 3.81; 95% CI, 1.13-11.82; P = .021) were independent predictors for disease-free survival (DFS).
Salvage surgery for larynx carcinoma, regardless of disease stage and other prognostic factors, results in more favorable loco(regional) control but not favorable DFS than pharyngeal carcinoma. The observed difference in DFS between salvage surgery for local and regional recurrences was not significant after correction for confounders. However, survival following salvage surgery for locoregional disease is significantly worse. For this subgroup, we propose to consider T status and comorbidity for clinical decision making, as high pT stage and ASA score are independent predictors for worse DFS.
大多数报道头颈部鳞状细胞癌（HNSCC）根治性放疗后挽救性手术的研究规模较小且存在异质性。因此，一些相关问题仍未得到解答。我们特别关注（1）根据疾病分期校正后的肿瘤亚部位预后差异，以及（2）局部、区域和局部区域复发后挽救性手术的预后差异。
回顾性分析。
单中心研究（2000-2016 年）。
对接受挽救性手术治疗的 HNSCC 复发患者进行研究。
共纳入 189 例患者。5 年总生存率（OS）为 33%，中位 OS 为 18（95%置信区间[CI]，11-26）个月。与治疗相关的死亡率为 2%。喉癌的局部（校正危险比[HR] = 4.02；95%CI，1.46-11.10；P =.007）和局部区域控制（校正 HR = 5.34；95%CI，1.83-15.61；P =.002）优于咽癌。美国麻醉医师协会（ASA）评分（≥3 分与 1-2 分：校正 HR = 3.04；95%CI，1.17-7.91；P =.023）、pT 分期（3-4 期与 1-2 期：校正 HR = 4.41；95%CI，1.65-11.82；P =.003）和局部区域复发的挽救性手术（局部区域与局部：校正 HR = 3.81；95%CI，1.13-11.82；P =.021）是无病生存（DFS）的独立预测因素。
喉癌的挽救性手术，无论疾病阶段和其他预后因素如何，局部（区域）控制的效果都优于咽癌，但DFS 无明显改善。在校正混杂因素后，局部和区域复发的挽救性手术的DFS 差异无统计学意义。然而，局部区域疾病的挽救性手术后生存明显更差。对于这一亚组，我们建议考虑 T 分期和合并症以做出临床决策，因为高 pT 分期和 ASA 评分是 DFS 较差的独立预测因素。
