Plath Michaela, Thielen Hannah M, Baumann Ingo, Zaoui Karim, Federspil Philippe A
Department of Otorhinolaryngology, Heidelberg University Hospital, Heidelberg, Germany.
Clin Exp Otorhinolaryngol. 2020 May;13(2):164-172. doi: 10.21053/ceo.2019.00192. Epub 2019 Aug 3.
The reconstruction after nasal skin cancer (NSC) resection is often practiced differently. The objective of this study is to evaluate the influence of patient-, tumor- and management-related factors on the role of surgery and choice of reconstruction.
This was a monocentric retrospective study of patients who were diagnosed with a NSC (squamous cell or basal cell carcinoma) and suffered from an extended defect after ablative surgery between 2003 and 2013. Twenty-five patients were included. Tumors were staged using the Union for International Cancer Control (eighth edition) TNM classification for primary cutaneous skin cancer of the head and neck. Preferred treatment was surgery in all patients. Health-related quality of life (HRQoL) measurement was evaluated by one generic (36-Item Short Form Health Survey [SF-36]) and two organ-specific questionnaires (Rhinoplasty Outcome Evaluation [ROE] and Functional Rhinoplasty Outcome Inventory 17 [FROI-17]) after therapy. Survival data were estimated by the Kaplan-Meier method and statistical analysis was performed by log-rank, analysis of variance, Levene's and t-tests. The median follow-up time was 2.1 years.
According to the Union for International Cancer Control classification, 13 of 25 tumors were staged as pT1 (52%), four as pT2 (16%), seven as pT3 (28%) and one as pT4a (4%). Seventy-two percent of patients (n=18) chose plastic reconstruction, and for the remaining 28% (n=7) of the patients opted for an implant-retained prosthesis. The overall survival was 69.5% after 5 years, the 5-year recurrence-free survival was 90.9% and the 5-year disease-specific survival was 100%. There was no significant difference in the HRQoL outcome between both rehabilitation methods.
Surgery in NSC gives an excellent oncologic prognosis. Nasal reconstruction and prostheses are both very viable options depending on tumor stage and biology, the patient's wishes as well as the experience of the surgeon.
鼻皮肤癌（NSC）切除术后的重建方式通常差异较大。本研究的目的是评估患者、肿瘤及治疗相关因素对手术作用及重建方式选择的影响。
这是一项单中心回顾性研究，研究对象为2003年至2013年间被诊断为NSC（鳞状细胞癌或基底细胞癌）且在切除术后存在广泛性缺损的患者。共纳入25例患者。采用国际癌症控制联盟（第八版）头颈部原发性皮肤癌TNM分类对肿瘤进行分期。所有患者的首选治疗方法均为手术。治疗后通过一份通用问卷（36项简短健康调查[SF - 36]）和两份器官特异性问卷（鼻整形术结果评估[ROE]和功能性鼻整形术结果量表17[FROI - 17]）对健康相关生活质量（HRQoL）进行评估。生存数据采用Kaplan - Meier法估算，统计分析采用对数秩检验、方差分析、Levene检验和t检验。中位随访时间为2.1年。
根据国际癌症控制联盟分类，25例肿瘤中13例为pT1期（52%），4例为pT2期（16%），7例为pT3期（28%），1例为pT4a期（4%）。72%的患者（n = 18）选择了整形重建，其余28%（n = 7）的患者选择了植入式假体。5年后总生存率为69.5%，5年无复发生存率为90.9%，5年疾病特异性生存率为100%。两种康复方法在HRQoL结果方面无显著差异。
NSC手术具有良好的肿瘤学预后。根据肿瘤分期、生物学特性、患者意愿以及外科医生的经验，鼻重建和假体都是非常可行的选择。
