颅面部病变眶内容剜除术的结果。

Outcomes of orbital exenteration for craniofacial lesions.

机构信息

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

Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas.

出版信息

Cancer. 2021 Jul 15;127(14):2465-2475. doi: 10.1002/cncr.33526. Epub 2021 Apr 2.

DOI:10.1002/cncr.33526

PMID:33799313

Abstract

BACKGROUND

Orbital exenteration (OE) is an ablative procedure used in the management of malignancies of the orbit of either primary or secondary origin. Publications evaluating this procedure have suffered from small patient numbers, heterogeneity of pathologies, and poor patient follow-up. The purpose of this study was to assess patient outcomes in a large cohort of patients undergoing OE at a tertiary cancer center.

METHODS

A retrospective review was conducted of 180 consecutive patients who underwent OE at the authors' institution. Overall survival (OS) was the primary end point measured in the study. Time to locoregional recurrence (progression-free survival [PFS]) and disease-free survival were secondary end points.

RESULTS

Between the years 1993 and 2011, 180 consecutive patients received OE for craniofacial malignancy at the authors' institution. The median follow-up for the cohort was 9.7 years (116 months). The median OS was 73 months, and the median PFS was 96 months. The presence of perineural invasion was associated with shorter OS (P = .01) and PFS (P < .01). Magnetic resonance imaging was predictive of perineural invasion (P < .01). Positive margins were associated with shorter PFS than negative margins (P < .01) but with no change in OS (P = .15). The overall complication rate was 15%. The major complication rate (Clavien-Dindo 3b or greater) was 2.8% (n = 5), and there was 1 death observed (0.6%).

CONCLUSIONS

Used judiciously in the setting of a multidisciplinary management plan, OE for tumor control is a safe therapy.

LAY SUMMARY

Between the years 1993 and 2011, 180 consecutive patients received orbital exenteration for craniofacial malignancy at the MD Anderson Cancer Center. The median follow-up for the cohort was 9.7 years. The presence of perineural invasion was associated with shorter overall survival (P = .01) and progression-free survival (P < .01). Magnetic resonance imaging was predictive of perineural invasion (P < .01). Positive margins were associated with shorter progression-free survival than negative margins (P < .01). The overall complication rate was 15%. The major complication rate (Clavien-Dindo 3b or greater) was 2.8% (n = 5).

摘要

背景

眼眶内容剜除术（OE）是一种用于治疗原发性或继发性眼眶恶性肿瘤的切除术。评估该手术的出版物存在患者数量少、病变异质性和患者随访不良等问题。本研究的目的是在一家三级癌症中心评估大量接受 OE 手术患者的治疗结果。

方法

对作者所在机构的 180 例连续接受 OE 手术的患者进行回顾性研究。本研究的主要终点是总生存率（OS）。无局部区域复发（无进展生存期[PFS]）和无疾病生存率是次要终点。

结果

1993 年至 2011 年间，作者所在机构对 180 例颅面部恶性肿瘤患者连续行 OE 治疗。该队列的中位随访时间为 9.7 年（116 个月）。中位 OS 为 73 个月，中位 PFS 为 96 个月。神经周围侵犯与较短的 OS（P=0.01）和 PFS（P<0.01）相关。磁共振成像（MRI）可预测神经周围侵犯（P<0.01）。阳性切缘与较短的 PFS 相关（P<0.01），但与 OS 无变化（P=0.15）相关。总的并发症发生率为 15%。主要并发症发生率（Clavien-Dindo 3b 或更高）为 2.8%（n=5），观察到 1 例死亡（0.6%）。