选择性舌扁桃体切除术比治疗性舌根 TORS 术后急性发病率低。
TORS elective lingual tonsillectomy has less acute morbidity than therapeutic base of tongue TORS.
机构信息
Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States.
Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, United States.
出版信息
Oral Oncol. 2021 Jun;117:105294. doi: 10.1016/j.oraloncology.2021.105294. Epub 2021 Apr 17.
OBJECTIVE
To determine the impact of diagnostic TORS lingual tonsillectomy (DTLT) on objective swallowing measures for carcinoma of unknown primary (CUP).
METHODS
Between 10/2016-1/2020, 27 patients with p16+ squamous cell carcinoma (SCC) level 2a nodal disease underwent DTLT and ipsilateral neck dissection for CUP. No patient had a history of cutaneous SCC. Patients participated in Modified Barium Swallow (MBS) three weeks post-TORS, which were then compared to those from a contemporaneous cohort of 40 patients with clinically-identified p16+ base of tongue (BOT) primary tumors. DIGEST scores were retrospectively calculated. Univariate and multivariate analysis performed, stratified by BOT glossectomy (n = 40) versus lingual tonsillectomy for CUP (n = 27). Radiation to the resected primary or potential primary sources was omitted if margins were ≥3 mm or if no primary identified.
RESULTS
Twenty-seven consecutive patients with clinical stage cT0N1 HPV-associated OPSCC had a BOT primary pathologically identified in 18/27 (67%). Univariate analysis of functional swallow assessment on MBSImP correlated with improved post-TORS DIGEST scores for CUP. On multivariate analysis (MVA) DIGEST safety scores were improved for CUP than cT1 BOT glossectomy [Odds Ratio (OR) 0.28, p = 0.038]. MVA on matched pT1 CUP (n = 27) vs. pT1 BOT (n = 19), OR of moderate/severe dysphagia for CUP was 0.54 [0.12-2.38, p = 0.417] for DIGEST safety scores and 0.27 [0.06-1.18, p = 0.082] for DIGEST efficiency scores. Moderate/severe dysphagia as determined by DIGEST overall scores for CUP compared to cT1 and pT1 yielded an OR of 0.39 (p = 0.081) and 0.42 (p = 0.195), respectively. Twenty-six total patients received adjuvant RT, and 18 (11 with ≥3 mm margins, 9 with negative specimens) were spared intentional RT to the oropharynx. Median follow-up was 22.6 months with 100% PFS.
CONCLUSIONS
Patients undergoing DTLT for CUP demonstrated acute swallow defecits in the post-operative setting. A comparison of long-term functional results between DTLT and elective irradiation of the primary site should be studied.
LEVEL OF EVIDENCE
Level III.
目的
确定诊断性经口机器人手术（TORS）舌扁桃体切除术（DTLT）对不明原发灶（CUP）的鳞状细胞癌患者客观吞咽指标的影响。
方法
2016 年 10 月至 2020 年 1 月，27 例 p16+ Ⅱa 期颈部淋巴结转移的鳞癌患者接受 DTLT 及同侧颈清扫术治疗 CUP。所有患者均无皮肤鳞癌病史。患者于 TORS 后 3 周接受改良吞咽造影检查（MBS），并与同期 40 例经临床诊断为 p16+舌根原发肿瘤的患者进行比较。回顾性计算 DIGEST 评分。对 40 例舌根行扁桃体切除术和 27 例 TORS 舌扁桃体切除术的患者进行单变量和多变量分析，分层分析。如果切缘≥3mm 或未发现原发灶，则不进行切除原发灶或潜在原发灶的放射治疗。
结果
27 例连续的临床分期为 cT0N1HPV 相关口咽鳞癌患者中，18/27（67%）患者在病理上发现了舌根部有原发肿瘤。MBSImP 上的吞咽功能评估的单变量分析与 TORS 后 DIGEST 评分的改善相关。多变量分析（MVA）显示，与 cT1 舌根扁桃体切除术相比，CUP 的 DIGEST 安全性评分改善（比值比[OR]为 0.28，p=0.038）。在匹配的 pT1 CUP（n=27）与 pT1 舌根（n=19）患者中，CUP 组中度/重度吞咽困难的 OR 为 0.54[0.12-2.38，p=0.417]，DIGEST 安全性评分的 OR 为 0.27[0.06-1.18，p=0.082]，DIGEST 效率评分的 OR 为 0.27[0.06-1.18，p=0.082]。与 cT1 和 pT1 相比，CUP 患者的 DIGEST 总体评分中度/重度吞咽困难的 OR 为 0.39（p=0.081）和 0.42（p=0.195）。26 例患者接受了辅助放疗，18 例（11 例切缘≥3mm，9 例标本阴性）避免了对口咽部的意向性放疗。中位随访时间为 22.6 个月，无进展生存率为 100%。
结论
行 DTLT 治疗 CUP 的患者在术后出现急性吞咽障碍。应研究 DTLT 与原发性疾病选择性放疗的长期功能结果比较。
证据水平
III 级。
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