腮腺切除术在头颈部晚期皮肤鳞状细胞癌中的作用。
The role of parotidectomy for advanced cutaneous squamous cell carcinoma of the head and neck.
机构信息
Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Radiation Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Eur Arch Otorhinolaryngol. 2021 Oct;278(10):3955-3963. doi: 10.1007/s00405-020-06574-8. Epub 2021 Jan 6.
PURPOSE
Regionally metastatic cutaneous squamous cell carcinoma of the head and neck (CSCCHN) is usually managed surgically; however, the role of parotidectomy remains controversial. Herein we elucidate the controversy and present our experience.
METHODS
We retrospectively analyzed disease variables, extent of parotidectomy, and pathologic characteristics in association to outcome measures of all advanced CSCCHN patients who underwent definitive surgical resection from 2008 to 2018.
RESULTS
Sixty-seven patients were enrolled, of whom 47 (70%) underwent parotidectomy; 27 superficial and 20 that included deep lobe resection. Parotidectomy had improved 5-year overall survival (OS) and disease-free survival (DFS) when neck was clinically involved (67.6% vs. 22.2%, P = 0.003 and 75.8% vs. 33.3% P = 0.002, respectively). Elective parotidectomy did not confer survival benefit for patients with no clinical involvement of the parotid gland (41.7% vs. 35%, P = 0.977). Recurrent disease was predictive for parotid metastases (P = 0.034). Thirty-nine patients received adjuvant radiotherapy, which significantly improved OS and DFS versus surgery alone (70.7% vs. 38.1%, P = 0.004 and 77.8% vs. 57.9%, P = 0.014, respectively).
CONCLUSION
Parotidectomy was associated with improved survival of cervically spread CSCCHN.
目的
头颈部皮肤鳞状细胞癌（CSCCHN）的区域性转移性疾病通常采用手术治疗；然而，腮腺切除术的作用仍存在争议。在此，我们阐明了这一争议并介绍了我们的经验。
方法
我们回顾性分析了 2008 年至 2018 年所有接受确定性手术切除的晚期 CSCCHN 患者的疾病变量、腮腺切除术范围和病理特征，并将其与预后指标相关联。
结果
共纳入 67 例患者，其中 47 例（70%）接受了腮腺切除术；27 例为浅叶切除术，20 例为包括深叶切除术。当颈部临床受累时，腮腺切除术改善了 5 年总生存率（OS）和无病生存率（DFS）（67.6%比 22.2%，P=0.003 和 75.8%比 33.3%，P=0.002）。对于没有腮腺临床受累的患者，选择性腮腺切除术并没有带来生存获益（41.7%比 35%，P=0.977）。复发性疾病是腮腺转移的预测因素（P=0.034）。39 例患者接受了辅助放疗，与单纯手术相比，OS 和 DFS 显著提高（70.7%比 38.1%，P=0.004 和 77.8%比 57.9%，P=0.014）。
结论
腮腺切除术与颈淋巴结转移的 CSCCHN 患者的生存改善相关。
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