Li Min, Xie Ming, Zhou Liang, Wang Shuyi
a Department of Head and Neck Surgery , Eye and ENT Hospital of Fudan University , Shanghai , China.
b Department of Pathology , Eye and ENT Hospital of Fudan University , Shanghai , China.
Acta Otolaryngol. 2018 Dec;138(12):1136-1145. doi: 10.1080/00016489.2018.1524585. Epub 2019 Jan 28.
The extent of surgical safety margin remained unclear in hypopharyngeal carcinoma surgery.
The purpose of this study was to evaluate the influence of surgical margin status on the outcomes of patients with advanced hypopharyngeal carcinoma.
A retrospective analysis of clinical data was performed in 205 patients with stage III/IV hypopharyngeal carcinoma treated by primary surgery between January 2005 and December 2014. There were 129 patients with clear surgical margins (≥5 mm) and 76 with close surgical margins (<5 mm). The clinical characteristics and treatment outcomes were compared between the two groups.
Close surgical margin (cSM) was found to be a significant risk factor for local recurrence, overall survival (OS) and disease-specific survival (DSS). Analysis by stratification according to pT classification showed that the OS and DSS rates of T1/T2 tumors with clear surgical margins (nSM) were significantly higher than those with cSM (p < .05), while there was no significant difference in the OS and DSS rates between T3/T4 tumors with cSM and nSM (p > .05).
The tailored extent of surgical resection margin was recommended for locally advanced hypopharyngeal carcinomas according to primary tumor stage.
下咽癌手术中手术切缘安全范围仍不明确。
本研究旨在评估手术切缘状态对晚期下咽癌患者预后的影响。
对2005年1月至2014年12月期间接受初次手术治疗的205例III/IV期下咽癌患者的临床资料进行回顾性分析。其中手术切缘阴性（≥5 mm）者129例，手术切缘阳性（<5 mm）者76例。比较两组患者的临床特征和治疗效果。
手术切缘阳性（cSM）是局部复发、总生存（OS）和疾病特异性生存（DSS）的显著危险因素。根据pT分类进行分层分析显示，手术切缘阴性（nSM）的T1/T2肿瘤患者的OS和DSS率显著高于手术切缘阳性者（p < 0.05），而手术切缘阳性和阴性的T3/T4肿瘤患者的OS和DSS率无显著差异（p > 0.05）。
对于局部晚期下咽癌，建议根据原发肿瘤分期调整手术切除切缘范围。
