单模态经口机器人手术治疗 HPV 相关口咽鳞状细胞癌患者中手术切缘对局部控制的影响。
Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
出版信息
Head Neck. 2021 Aug;43(8):2434-2444. doi: 10.1002/hed.26708. Epub 2021 Apr 15.
Abstract
BACKGROUND
The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear.
METHODS
Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan-Meier method.
RESULTS
Ninety-nine patients were included (median follow-up 21 months, range 6-121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins.
CONCLUSIONS
Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.
摘要
背景
HPV 相关口咽鳞状细胞癌（HPV+OPSCC）中，手术切缘接近对肿瘤学结果的影响尚不清楚。
方法
这是一项回顾性病例系列研究，纳入了 2010 年至 2019 年期间在三个学术医疗中心接受单一模式经口机器人手术（TORS）治疗的 HPV+OPSCC 患者。使用 Kaplan-Meier 法比较切缘接近（<1mm 或需要再次切除）和切缘清晰的患者的结局。
结果
共纳入 99 例患者（中位随访时间 21 个月，范围 6-121 个月）。22 例（22.2%）患者的最终切缘接近，75 例（75.8%）患者的切缘清晰，2 例（2.0%）患者的切缘阳性。8 例（8.1%）患者复发，包括 2 例局部复发（2.0%）。4 例患者在研究期间死亡（4.0%）。局部控制（p=0.470）、无病生存率（p=0.513）和总生存率（p=0.064）在切缘接近和切缘清晰的患者之间无差异。
结论
对于接受 TORS 治疗的 HPV+OPSCC 患者，如果没有辅助治疗的指征，且切缘接近，可考虑单独观察。
相似文献
1
Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma.单模态经口机器人手术治疗 HPV 相关口咽鳞状细胞癌患者中手术切缘对局部控制的影响。
Head Neck. 2021 Aug;43(8):2434-2444. doi: 10.1002/hed.26708. Epub 2021 Apr 15.
2
Specimen-Based Resection Margins and Local Control during Transoral Robotic Surgery for Oropharyngeal HPV-Mediated Squamous Cell Carcinoma.口咽人乳头瘤病毒介导的鳞状细胞癌经口机器人手术中基于标本的切缘与局部控制
ORL J Otorhinolaryngol Relat Spec. 2023;85(2):80-87. doi: 10.1159/000527369. Epub 2022 Dec 20.
3
Oncological outcomes post transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma, a single-centre retrospective Australian study.经口机器人手术（TORS）治疗 HPV 相关口咽鳞状细胞癌的肿瘤学结果：单中心回顾性澳大利亚研究。
J Robot Surg. 2024 May 28;18(1):226. doi: 10.1007/s11701-024-01910-0.
4
Long-term survival outcomes after primary transoral robotic surgery (TORS) with concurrent neck dissection for early-stage oropharyngeal squamous cell carcinoma.经口机器人手术（TORS）同期颈清扫术治疗早期口咽鳞状细胞癌的长期生存结果。
Acta Otolaryngol. 2021 Jul;141(7):714-718. doi: 10.1080/00016489.2021.1939147. Epub 2021 Jun 30.
5
HPV/p16-positive oropharyngeal cancer treated with transoral robotic surgery: The roles of margins, extra-nodal extension and adjuvant treatment.HPV/p16 阳性口咽癌经口机器人手术治疗：切缘、淋巴结外侵犯及辅助治疗的作用。
Am J Otolaryngol. 2021 Jan-Feb;42(1):102793. doi: 10.1016/j.amjoto.2020.102793. Epub 2020 Oct 24.
6
Transoral robotic surgery versus nonrobotic resection of oropharyngeal squamous cell carcinoma.经口机器人手术与非机器人手术切除口咽鳞状细胞癌的比较。
Head Neck. 2021 Jul;43(7):2259-2273. doi: 10.1002/hed.26724. Epub 2021 Apr 26.
7
Outcomes of transoral robotic surgery for early-stage oropharyngeal squamous cell carcinoma with low rates of adjuvant therapy: A consecutive single-institution study from 2013 to 2020.2013 年至 2020 年连续单机构研究：低辅助治疗率的早期口咽鳞状细胞癌经口机器人手术治疗的结果。
Oral Oncol. 2024 May;152:106783. doi: 10.1016/j.oraloncology.2024.106783. Epub 2024 Apr 2.
8
Risk of Pathologic Extranodal Extension and Other Adverse Features After Transoral Robotic Surgery in Patients With HPV-Positive Oropharynx Cancer.HPV 阳性口咽癌患者经口机器人手术后病理性结外延伸及其他不良特征的风险。
JAMA Otolaryngol Head Neck Surg. 2021 Dec 1;147(12):1080-1088. doi: 10.1001/jamaoto.2021.2777.
9
Association of Intraoperative Frozen Section Controls With Improved Margin Assessment During Transoral Robotic Surgery for Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma.术中冰冻切片控制与 HPV 阳性口咽鳞状细胞癌经口机器人手术中改善切缘评估的关联。
JAMA Otolaryngol Head Neck Surg. 2022 Nov 1;148(11):1029-1037. doi: 10.1001/jamaoto.2022.2840.
10
Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS).HPV+ 口咽鳞状细胞癌经口机器人手术（TORS）治疗后的颈淋巴结阳性模式、区域性失败率和瘘管率。
Oral Oncol. 2018 Nov;86:296-300. doi: 10.1016/j.oraloncology.2018.10.001. Epub 2018 Oct 13.
引用本文的文献
1
Evidence-based guideline diagnosis, treatment, prevention and aftercare of oropharyngeal and hypopharyngeal carcinoma.口咽癌和下咽癌基于证据的诊断、治疗、预防及术后护理指南
Ger Med Sci. 2025 Jun 24;23:Doc03. doi: 10.3205/000339. eCollection 2025.
2
Surgical margins after open versus transoral surgery for oropharyngeal cancer and their impact on the need for multimodal treatments.口咽癌开放手术与经口手术的手术切缘及其对多模式治疗需求的影响。
Acta Otorhinolaryngol Ital. 2025 May;45(Suppl. 1):S15-S24. doi: 10.14639/0392-100X-suppl.1-45-2025-N1027.
3
Use of Intraoperative Frozen Section to Assess Surgical Margins in HPV-Related Oropharyngeal Carcinoma.术中冰冻切片在人乳头瘤病毒相关口咽癌手术切缘评估中的应用
JAMA Otolaryngol Head Neck Surg. 2025 Mar 1;151(3):253-262. doi: 10.1001/jamaoto.2024.4869.
4
Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Cancer.新辅助化疗与经口机器人手术治疗人乳头瘤病毒相关口咽癌
JAMA Otolaryngol Head Neck Surg. 2025 Feb 1;151(2):128-134. doi: 10.1001/jamaoto.2024.3303.
5
Do We Have Enough Evidence to Specifically Recommend Transoral Robotic Surgery in HPV-Driven Oropharyngeal Cancer? A Systematic Review.我们是否有足够的证据明确推荐在人乳头瘤病毒（HPV）驱动的口咽癌中采用经口机器人手术？一项系统评价。
Pathogens. 2023 Jan 18;12(2):160. doi: 10.3390/pathogens12020160.
6
Surgical clinical trials for HPV-positive oropharyngeal carcinoma.人乳头瘤病毒阳性口咽癌的外科临床试验。
Front Oncol. 2022 Nov 9;12:992348. doi: 10.3389/fonc.2022.992348. eCollection 2022.
7
Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma of the Tonsil versus Base of Tongue: A Systematic Review and Meta-Analysis.经口机器人手术治疗扁桃体与舌根口咽鳞状细胞癌：系统评价与荟萃分析
Cancers (Basel). 2022 Aug 8;14(15):3837. doi: 10.3390/cancers14153837.
8
Practice patterns in transoral robotic surgery: results of an American head and neck society survey.经口机器人手术的实践模式：美国头颈学会调查结果。
J Robot Surg. 2023 Apr;17(2):549-556. doi: 10.1007/s11701-022-01448-z. Epub 2022 Aug 7.
9
Robotic vs. transoral laser surgery of malignant oropharyngeal tumors-what is best for the patient? : A contemporary review.机器人手术与经口激光手术治疗口咽恶性肿瘤——哪种对患者最有利？：当代综述
HNO. 2022 May;70(5):371-379. doi: 10.1007/s00106-022-01165-x. Epub 2022 Apr 13.
10
Cell-free human papillomavirus DNA kinetics after surgery for human papillomavirus-associated oropharyngeal cancer.手术后人类乳头瘤病毒相关口咽癌的游离人乳头瘤病毒 DNA 动力学。
Cancer. 2022 Jun 1;128(11):2193-2204. doi: 10.1002/cncr.34109. Epub 2022 Feb 9.
本文引用的文献
1
A systematic review and meta-analysis of margins in transoral surgery for oropharyngeal carcinoma.经口手术治疗口咽癌的切缘分析：系统评价和荟萃分析。
Oral Oncol. 2019 Nov;98:69-77. doi: 10.1016/j.oraloncology.2019.09.017. Epub 2019 Sep 20.
2
Treatment trends in oropharyngeal carcinoma: Surgical technology meets the epidemic.口咽癌治疗趋势：外科技术应对疫情。
Oral Oncol. 2019 Oct;97:62-68. doi: 10.1016/j.oraloncology.2019.08.007. Epub 2019 Aug 14.
3
Treatment modality impact on quality of life for human papillomavirus-associated oropharynx cancer.治疗方式对人乳头瘤病毒相关性口咽癌患者生活质量的影响。
Laryngoscope. 2020 Feb;130(2):E48-E56. doi: 10.1002/lary.27937. Epub 2019 Mar 27.
4
Transoral Robotic Surgery (TORS) for Bilateral Eagle Syndrome.经口机器人手术治疗双侧茎突综合征
ORL J Otorhinolaryngol Relat Spec. 2019;81(1):36-40. doi: 10.1159/000493736. Epub 2018 Dec 11.
5
Utilization of Transoral Robotic Surgery (TORS) in patients with Oropharyngeal Squamous Cell Carcinoma and its impact on survival and use of chemotherapy.经口机器人手术（TORS）在口咽鳞状细胞癌患者中的应用及其对生存和化疗使用的影响。
Oral Oncol. 2018 Nov;86:75-80. doi: 10.1016/j.oraloncology.2018.06.009. Epub 2018 Sep 15.
6
Perineural invasion: Independent prognostic factor in oral cancer that warrants adjuvant treatment.神经周围侵犯：口腔癌的独立预后因素，需要辅助治疗。
Head Neck. 2018 Aug;40(8):1780-1787. doi: 10.1002/hed.25170. Epub 2018 Apr 29.
7
Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus.人乳头瘤病毒时代口咽鳞状细胞癌的经口机器人手术
Head Neck. 2018 Apr;40(4):710-721. doi: 10.1002/hed.25036. Epub 2017 Dec 15.
8
Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer.口咽癌患者经口机器人手术后的长期功能和生活质量结果
JAMA Otolaryngol Head Neck Surg. 2018 Jan 1;144(1):18-27. doi: 10.1001/jamaoto.2017.1790.
9
Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer.经口机器人手术联合或不联合辅助治疗口咽癌的生活质量结局
Laryngoscope. 2018 Feb;128(2):403-411. doi: 10.1002/lary.26796. Epub 2017 Aug 3.
10
Definition of "Close Margin" in Oral Cancer Surgery and Association of Margin Distance With Local Recurrence Rate.口腔癌手术中“Close Margin”的定义及切缘距离与局部复发率的关系。
JAMA Otolaryngol Head Neck Surg. 2017 Dec 1;143(12):1166-1172. doi: 10.1001/jamaoto.2017.0548.
Zotero 插件