Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2021 Jun;164(6):1222-1229. doi: 10.1177/0194599820968800. Epub 2020 Nov 3.
Despite epidemiologic evidence that second primaries occur infrequently in HPV (human papillomavirus)-associated oropharyngeal squamous cell carcinoma, recent recommendations advocate for elective contralateral palatine tonsillectomy. We aimed to study this discordance and define the necessary extent of up-front surgery in a large contemporary cohort with long-term follow-up treated with unilateral transoral robotic surgery. We hypothesized that second primaries are discovered exceedingly rarely during follow-up and that survival outcomes are not compromised with a unilateral surgical approach.
Retrospective cohort analysis.
Tertiary care academic center between 2007 and 2017.
Records for patients with p16-positive oropharyngeal squamous cell carcinoma of the tonsil and workup suggestive of unilateral disease who underwent ipsilateral transoral robotic surgery were analyzed for timing and distribution of locoregional recurrence, distant metastases, and second primary occurrence as well as survival characteristics.
Among 295 included patients, 21 (7.1%) had a locoregional recurrence; 17 (5.8%) had a distant recurrence; and 3 (1.0%) had a second primary during a median follow-up of 48.0 months (interquartile range, 29.5-62.0). Only 1 (0.3%) had a second primary found in the contralateral tonsil. The 2- and 5-year estimates of overall survival were 95.5% (SE, 1.2%) and 90.1% (SE, 2.2%), respectively, while the 2- and 5-year estimates of disease-free survival were 90.0% (SE, 1.8%) and 84.7% (SE, 2.3%).
Second primary occurrence in the contralateral tonsil was infrequent, and survival outcomes were encouraging with unilateral surgery. This provides a rationale for not routinely performing elective contralateral tonsillectomy in patients whose workup suggests unilateral disease.
尽管流行病学证据表明 HPV（人乳头瘤病毒）相关口咽鳞状细胞癌中很少发生第二原发癌，但最近的建议主张选择性对侧软腭扁桃体切除术。我们旨在通过一项大型当代队列研究来研究这种差异，并在接受单侧经口机器人手术治疗的患者中定义前期手术的必要范围，这些患者具有长期随访结果。我们假设在随访过程中极少发现第二原发癌，且单侧手术方法不会影响生存结果。
回顾性队列分析。
2007 年至 2017 年期间，在一家三级保健学术中心进行。
对诊断为 16 阳性扁桃体口咽鳞状细胞癌且检查提示单侧疾病的患者的记录进行分析，这些患者接受了同侧经口机器人手术，分析其局部区域复发、远处转移和第二原发癌的发生时间和分布，以及生存特征。
在 295 例纳入的患者中，21 例（7.1%）出现局部区域复发；17 例（5.8%）出现远处转移；3 例（1.0%）在中位随访 48.0 个月（四分位距，29.5-62.0）期间发生第二原发癌。仅有 1 例（0.3%）在对侧扁桃体中发现第二原发癌。总生存率的 2 年和 5 年估计值分别为 95.5%（SE，1.2%）和 90.1%（SE，2.2%），无疾病生存率的 2 年和 5 年估计值分别为 90.0%（SE，1.8%）和 84.7%（SE，2.3%）。
对侧扁桃体发生第二原发癌的情况很少见，单侧手术的生存结果令人鼓舞。这为那些检查提示单侧疾病的患者不常规进行选择性对侧扁桃体切除术提供了依据。
