Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France.
Eur J Surg Oncol. 2021 Jul;47(7):1718-1726. doi: 10.1016/j.ejso.2021.01.022. Epub 2021 Jan 29.
The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting.
The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications.
With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications.
When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.
在先前放射治疗过的区域进行头颈部鳞状细胞癌（SCC）挽救性手术相关的风险需要与预期的生存获益相平衡。我们旨在确定挽救性手术治疗放射性复发性 SCC 后总生存（OS）/疾病特异性生存（DSS）和严重（Clavien-Dindo，CD≥III）并发症的发生的术前预测因素，以帮助外科医生、患者和护理人员在这种情况下做出决策。
回顾了在洛林癌症研究所就诊的 234 例局部复发性 SCC 患者的记录。主要终点是 OS，次要终点是 DSS、无气管造口术/胃造口术的 OS 和 CD≥III 并发症的风险。进行多变量分析以探讨与生存和术后并发症风险相关的术前因素。
中位随访时间为 19 个月，首次挽救性手术后 5 年 OS 为 28.3%，5 年 DSS 为 38.9%。2 年和 5 年的功能 OS 分别为 45.6%和 27.2%。rcT-rcN 和 WUNHCI≥4 均是 OS 和 DSS 的独立显著术前预测因素。术后 30 天并发症发生率为 44.4%（28 例 CD I，24 例 CD II，34 例 CD III，11 例 CD IV，7 例 CD V）。涉及 T+N 的挽救性手术和 WUHNCI≥4 的存在是 CD≥III 并发症的唯一独立预测因素。
在与患者和护理人员讨论复发性头颈部 SCC 的挽救性手术时，通过 WUHNCI 工具仔细评估术前合并症，可以可靠地预测手术的预期风险和获益。
