Division of Otolaryngology, General Hospital "Santa Maria Degli Angeli", Pordenone, Italy.
Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
Sci Rep. 2021 Jan 12;11(1):502. doi: 10.1038/s41598-020-79759-0.
Salvage surgery in recurrent head and neck squamous cell carcinoma has a poor outcome, both in terms of survival and quality of life. Therefore, the identification of pre-operative prognostic factors to improve the selection of patients who could benefit the most from salvage surgery is clinically relevant. The present study is a single-center retrospective analysis of 164 patients treated with salvage surgery after recurrence of head and neck cancer. Progression free survival and overall survival were calculated through Kaplan-Meier method. Hazard risk (HR) and corresponding confidence intervals (CI) were estimated through Cox proportional hazard model, adjusting for potential confounders. Significant predictors were combined into a prognostic score, attributing one point to each factor. Progression-free survival and overall survival were respectively 50.3% and 56.5% at 2 years, and 36.6% and 44.2% at 5 years. Four pre-operative factors were independently associated with poor prognosis: age > 70 years (HR = 2.18; 95% CI 1.27-3.73), initial stage IV (HR = 2.37; 95% CI 1.18-4.76), disease free interval < 12 months (HR = 1.72; 95% CI 1.01-2.94), and loco-regional recurrence (HR = 2.22; 95% CI 1.22-4.04). No post operative factor was associated with oncologic outcomes. Patients with 3-4 unfavorable factors showed a 5-year overall survival of 0.0% compared to 65.7% in those with 0-1 unfavorable factors (HR = 5.61; 95% CI 2.89-10.92). Despite the low number of patients, 3-4 unfavorable factors were associated to worse prognosis in all sub-sites. In conclusion, age > 70 years, initial stage IV, disease-free interval < 12 months, and loco-regional recurrence are strong independent pre-operative predictors of poor outcome in patients undergoing salvage surgery. Patients with two or more of these factors should be informed about the low success rate after salvage surgery and alternative treatments should be considered.
挽救性手术治疗头颈部鳞状细胞癌复发患者的预后较差，无论是在生存还是生活质量方面。因此，识别术前预后因素以改善最有可能从挽救性手术中获益的患者选择具有重要的临床意义。本研究为单中心回顾性分析 164 例头颈部癌复发后行挽救性手术的患者。通过 Kaplan-Meier 法计算无进展生存期和总生存期。通过 Cox 比例风险模型估计风险比（HR）及其相应的置信区间（CI），并对潜在混杂因素进行调整。将显著预测因素组合成一个预后评分，每个因素记 1 分。2 年时无进展生存率和总生存率分别为 50.3%和 56.5%，5 年时分别为 36.6%和 44.2%。术前 4 个因素与不良预后独立相关：年龄>70 岁（HR=2.18；95%CI 1.27-3.73）、初始 IV 期（HR=2.37；95%CI 1.18-4.76）、无疾病间期<12 个月（HR=1.72；95%CI 1.01-2.94）和局部区域复发（HR=2.22；95%CI 1.22-4.04）。术后无因素与肿瘤学结果相关。3-4 个不利因素的患者 5 年总生存率为 0.0%，而 0-1 个不利因素的患者为 65.7%（HR=5.61；95%CI 2.89-10.92）。尽管患者数量较少，但所有亚部位 3-4 个不利因素均与预后不良相关。总之，年龄>70 岁、初始 IV 期、无疾病间期<12 个月和局部区域复发是接受挽救性手术患者预后不良的独立强术前预测因素。有两个或更多这些因素的患者应被告知挽救性手术后成功率较低，并应考虑替代治疗方法。
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