接受经口机器人手术治疗口咽鳞状细胞癌患者辅助放化疗的预处理预测因素：一项病例对照研究
Pretreatment predictors of adjuvant chemoradiation in patients receiving transoral robotic surgery for squamous cell carcinoma of the oropharynx: a case control study.
作者信息
Subramanian Harry E, Park Henry S, Barbieri Andrea, Mahajan Amit, Judson Benjamin L, Mehra Saral, Yarbrough Wendell G, Burtness Barbara A, Husain Zain A
机构信息
1Department of Therapeutic Radiology, Yale University School of Medicine, PO Box 208040, New Haven, CT 06510 USA.
2Department of Pathology, Yale University School of Medicine, New Haven, CT USA.
出版信息
Cancers Head Neck. 2016 Jul 4;1:7. doi: 10.1186/s41199-016-0008-7. eCollection 2016.
BACKGROUND
The purpose of this study was to identify preoperative patient characteristics associated with the incidence of positive surgical margins or lymph node extracapsular extension (ECE), which necessitate adjuvant chemoradiation after transoral robotic surgery (TORS).
METHODS
We conducted a single institution retrospective study of 34 consecutive patients with primary oropharyngeal cancer who underwent TORS. All imaging was reviewed by a single neuroradiologist. Surgical margins and ECE status were determined by a single head and neck pathologist. Associations of preoperative patient characteristics with positive surgical margins and lymph node ECE were examined using univariate analysis. Independent predictors of these outcomes were determined using logistic regression.
RESULTS
Preoperatively, the majority of patients had early-stage disease (7 cT1 and 21 cT2; 10 cN0). Positive margins occurred in 4 (12 %) patients. A clinically positive lymph node was seen in 23 (68 %) patients. Neck dissection was performed in 29 (85 %) patients, among whom 19 had a pathologically positive lymph node and 15 had nodal ECE. Logistic regression showed that larger preoperative lymph node size was an independent predictor of ECE (odds ratio, 13.32 [95 % CI, 1.46-121.43]). Among the 21 patients with a clinically positive lymph node who underwent neck dissection, ECE was present more often in patients with a preoperative node size ≥ 3.0 vs. < 3.0 cm (92 % vs. 44 %, = 0.046). There was no patient characteristic associated with positive margins.
CONCLUSIONS
Patients with a larger preoperative lymph node appear more likely to have ECE, and thus be treated with chemoradiation after TORS, with a potentially higher rate of toxicity. Lymph node size should be taken into account when deciding upon treatment approaches. Further research is needed to validate these results.
背景
本研究的目的是确定与手术切缘阳性或淋巴结包膜外侵犯（ECE）发生率相关的术前患者特征，这些情况在经口机器人手术（TORS）后需要辅助放化疗。
方法
我们对34例连续接受TORS治疗的原发性口咽癌患者进行了单机构回顾性研究。所有影像学检查均由一名神经放射科医生进行评估。手术切缘和ECE状态由一名头颈病理科医生确定。采用单因素分析研究术前患者特征与手术切缘阳性和淋巴结ECE的相关性。使用逻辑回归确定这些结果的独立预测因素。
结果
术前，大多数患者为早期疾病（7例cT1和21例cT2；10例cN0）。4例（12%）患者出现切缘阳性。23例（68%）患者可见临床阳性淋巴结。29例（85%）患者进行了颈部清扫，其中19例有病理阳性淋巴结，15例有淋巴结ECE。逻辑回归显示，术前淋巴结较大是ECE的独立预测因素（比值比，13.32 [95% CI，1.46 - 121.43]）。在21例接受颈部清扫的临床阳性淋巴结患者中，术前淋巴结大小≥3.0 cm的患者比<3.0 cm的患者更常出现ECE（92%对44%，P = 0.046）。没有患者特征与切缘阳性相关。
结论
术前淋巴结较大的患者似乎更有可能出现ECE，因此在TORS后接受放化疗，毒性发生率可能更高。在决定治疗方法时应考虑淋巴结大小。需要进一步研究来验证这些结果。
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