Department of Otolaryngology Head and Neck Surgery, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109-5312, USA.
Department of Internal Medicine, Medical Oncology, University of Michigan, Ann Arbor, MI, USA.
Eur Arch Otorhinolaryngol. 2020 Jul;277(7):2085-2093. doi: 10.1007/s00405-020-05913-z. Epub 2020 Mar 19.
The incidence of oropharyngeal squamous cell carcinoma continues to rise with the majority of patients receiving definitive or adjunctive radiation. For patients with locoregional recurrence after radiation, optimal treatment involves salvage surgery. The aim of this study is to identify factors that predict survival to ultimately improve patient selection for salvage surgery.
Retrospective cohort study at an NCI-designated cancer center. We analyzed patients with a history of head and neck radiation who presented with persistent/recurrent or second primary disease requiring salvage oropharyngeal resection from 1998-2017 (n = 120). Patients were stratified into three classes based on time to recurrence and presence of laryngopharyngeal dysfunction. Primary outcomes were 5-year overall survival (OS) and disease specific survival (DSS).
Median OS was 27 months (median follow-up 20 months). Five-year OS was 47% for class I (recurrence > 2 years), 26% for class II (recurrence ≤ 2 years), and 0% for class III (recurrence ≤ 2 years and laryngopharyngeal dysfunction), (p < 0.0001). Five-year DSS showed significant differences between classes (p < 0.0001). On multivariate analysis, class remained predictive of OS (p = 0.04- < 0.001) and DSS (p = 0.04-0.001). Adjuvant radiation after salvage surgery with negative margins showed superior OS (71% vs. 28%, p = 0.01) and DSS (83% vs 37%, p = 0.02) compared to surgery alone and was a significant predictor of improved survival on multivariate analysis (HR 0.1, p = 0.04).
This study identified a subset of patients with oropharyngeal cancer recurrence within two years of initial treatment and with laryngopharyngeal dysfunction who have poor outcomes for salvage surgery.
口咽鳞状细胞癌的发病率持续上升，大多数患者接受根治性或辅助性放疗。对于放射治疗后局部区域复发的患者，最佳治疗方法是挽救性手术。本研究旨在确定预测生存的因素，最终改善挽救性手术的患者选择。
这是一项在国家癌症研究所指定的癌症中心进行的回顾性队列研究。我们分析了 1998 年至 2017 年间因头颈部放疗后持续性/复发性或需要挽救性口咽切除术的第二原发疾病而就诊的患者病史（n=120）。根据复发时间和喉咽功能障碍的存在，患者分为三组。主要结局是 5 年总生存率（OS）和疾病特异性生存率（DSS）。
中位 OS 为 27 个月（中位随访 20 个月）。5 年 OS 分别为 I 类（复发>2 年）为 47%，II 类（复发≤2 年）为 26%，III 类（复发≤2 年且喉咽功能障碍）为 0%（p<0.0001）。5 年 DSS 三组之间差异有统计学意义（p<0.0001）。多因素分析显示，分层仍与 OS（p=0.04- <0.001）和 DSS（p=0.04-0.001）相关。挽救性手术后行辅助放疗且切缘阴性的患者，OS（71% vs. 28%，p=0.01）和 DSS（83% vs. 37%，p=0.02）均优于单纯手术，且多因素分析显示为生存的显著预测因素（HR 0.1，p=0.04）。
本研究确定了一组口咽癌患者在初始治疗后两年内复发且伴有喉咽功能障碍，其挽救性手术的预后较差。
