Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA.
Division of Otolaryngology, Department of Surgery, University of California, San Diego, San Diego, CA.
Int Forum Allergy Rhinol. 2022 Nov;12(11):1350-1361. doi: 10.1002/alr.23000. Epub 2022 Mar 31.
Nasopharyngeal tumors (NPTs) are primarily treated with nonsurgical therapy. Recent studies have demonstrated endoscopic salvage surgery for NPT recurrences may improve survival relative to reirradiation. However, there are very limited data on open compared with endoscopic approaches for NPTs. We investigated whether endoscopic and open surgical approaches to the nasopharynx improve overall survival for all histologic subtypes of NPTs.
We performed a retrospective cohort study using the National Cancer Database (NCDB). All adult patients with NPTs from 2004 to 2016 without distant metastasis who underwent treatment with curative intent were included. We extracted clinical and treatment variables to assess our primary outcome of overall survival.
On univariate analysis, patients undergoing endoscopic surgery, but not open surgery, had significantly improved overall survival relative to those undergoing nonsurgical treatment. Post hoc analysis demonstrated significantly improved overall survival for surgery in patients with minor salivary gland histology, but not squamous cell carcinoma (SCC) histology or by T or N classification. A Cox proportional hazards model was used for multivariate regression. After adjusting for covariates, both endoscopic and open approaches were associated with improved overall survival relative to nonsurgical treatment for all tumor types. A multivariate regression of SCC found that open surgery, but not endoscopic surgery, was significantly associated with improved overall survival.
Both endoscopic and open surgical approaches are associated with improved overall survival of patients with NPT. These findings highlight important oncologic validity as endoscopic and robotic platforms to the nasopharynx become more widely adopted.
鼻咽肿瘤（NPTs）主要采用非手术治疗。最近的研究表明，对于 NPT 复发，内镜挽救性手术可能比再放疗更能提高生存率。然而，对于开放手术与内镜手术治疗 NPT 的比较，数据非常有限。我们研究了经内镜和开放性手术入路治疗是否能改善所有 NPT 组织学亚型的总生存率。
我们使用国家癌症数据库（NCDB）进行了一项回顾性队列研究。纳入了 2004 年至 2016 年间无远处转移且接受根治性治疗的所有 NPT 成年患者。我们提取了临床和治疗变量来评估我们的总生存率这一主要结局。
单因素分析显示，与未行手术治疗的患者相比，行内镜手术治疗的患者总生存率显著提高，但开放性手术治疗的患者则不然。事后分析表明，对于小唾液腺组织学类型的患者，手术治疗的总生存率显著提高，但对于鳞状细胞癌（SCC）组织学类型或 T 和 N 分类的患者则不然。我们采用 Cox 比例风险模型进行多变量回归。调整协变量后，内镜和开放性手术均与所有肿瘤类型的非手术治疗相比，总生存率提高相关。多变量回归分析 SCC 发现，开放性手术而非内镜手术与总生存率的提高显著相关。
经内镜和开放性手术入路均与 NPT 患者的总生存率提高相关。这些发现强调了内镜和机器人平台应用于鼻咽部时的重要肿瘤学有效性。
