新辅助化疗对头颈部癌症大手术后围手术期发病率的影响。

Impact of neoadjuvant chemotherapy on perioperative morbidity after major surgery for head and neck cancer.

机构信息

Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.

出版信息

Cancer. 2020 Oct 1;126(19):4304-4314. doi: 10.1002/cncr.33103. Epub 2020 Jul 24.

DOI:10.1002/cncr.33103

PMID:32706401

Abstract

BACKGROUND

Neoadjuvant chemotherapy (NAC) has been used in patients with advanced head and neck cancers (HNCs) with the intent of downstaging tumors and suppressing distant metastases. However, to the authors' knowledge, the perioperative impact of NAC has not been systematically explored in patients with HNC. The objective of the current study was to compare perioperative outcomes with surgery upfront compared with patients treated with NAC.

METHODS

Between March 1, 2016, and March 31, 2019, patients undergoing surgery for HNC with flap reconstruction at The University of Texas MD Anderson Cancer Center in Houston were included. Data were extracted from the prospectively maintained National Surgical Quality Improvement Program database. Postoperative complications, return to operating room, and readmission rates were compared. Univariate and multivariate analyses of length of stay and overall and wound complications were performed.

RESULTS

A total of 834 patients were analyzed, 687 of whom (82.4%) underwent surgery upfront and 147 of whom (17.6%) received NAC. A total of 631 cases (75.7%) involved the upper aerodigestive tract whereas 203 cases (24.3%) were cutaneous. A total of 317 patients (38.0%) had recurrent disease. The NAC group was younger (P < .001) and had less hypertension (P = .011), but had more advanced clinical stage tumors (P < .001) and surgeries with multiple flap reconstruction (P = .007). Patient groups did not differ with regard to wound complications (P = .47), return to operating room (P = .31), or readmission rates (P = .49). The NAC group received more blood transfusions (P < .001) but was found to have a lower risk of overall complications on multivariate analysis (odds ratio, 0.50; 95% CI, 0.30-0.83). The overall complication rate was unchanged with surgery performed ≤21 days after the last chemotherapy cycle.

CONCLUSIONS

Patients undergoing NAC appear to have a higher disease burden but tend to be younger and healthier. Within the context of this inherent selection bias, NAC does not appear to increase perioperative morbidity among patients undergoing surgery for HNC.

摘要

背景

新辅助化疗（NAC）已被用于治疗晚期头颈部癌症（HNC）患者，目的是降期肿瘤并抑制远处转移。然而，据作者所知，NAC 的围手术期影响尚未在 HNC 患者中得到系统探讨。本研究的目的是比较直接手术与接受 NAC 治疗的患者的围手术期结果。

方法

2016 年 3 月 1 日至 2019 年 3 月 31 日期间，在休斯顿德克萨斯大学 MD 安德森癌症中心接受 flap 重建的 HNC 手术患者纳入研究。数据来自前瞻性维护的国家手术质量改进计划数据库。比较术后并发症、重返手术室和再入院率。进行单变量和多变量分析以评估住院时间和总体及伤口并发症。

结果

共分析了 834 例患者，其中 687 例（82.4%）直接手术，147 例（17.6%）接受 NAC。总共 631 例（75.7%）涉及上呼吸道，203 例（24.3%）为皮肤。317 例（38.0%）为复发性疾病。NAC 组更年轻（P<.001）且高血压更少（P=.011），但临床分期肿瘤更晚期（P<.001），且多 flap 重建手术（P=.007）更多。两组患者在伤口并发症（P=.47）、重返手术室（P=.31）或再入院率（P=.49）方面无差异。NAC 组接受了更多的输血（P<.001），但在多变量分析中，总体并发症的风险较低（比值比，0.50；95%置信区间，0.30-0.83）。最后一次化疗周期后 ≤21 天进行手术，总体并发症发生率保持不变。