Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Dept. of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Dept. of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
Am J Otolaryngol. 2022 Sep-Oct;43(5):103527. doi: 10.1016/j.amjoto.2022.103527. Epub 2022 Jun 2.
Positive surgical margins (PSM) are associated with worse survival in oropharyngeal salivary gland malignancies (OPSGM), but existing literature is limited to small series. Our objective was to identify risk factors for PSM using the national cancer database (NCDB), including a transoral robotic surgical (TORS) approach.
NCDB was queried for patients with T1-T4a OPSGM undergoing resection between 2010 and 2017. Risk factors for PSM were determined using logistic regression. Overall survival (OS) was analyzed using Kaplan-Meier and Cox proportional hazards models.
Of 785 patients, 165 (21.0 %) had PSM. Age, stage T4a tumors (OR 2.00, 95 % Confidence Interval [CI]: 1.03-3.88), adenoid cystic carcinoma (OR 2.02, 95 % CI: 1.29-3.18), and treatment at lower volume institutions (OR 1.68, 95 % CI: 1.09-2.59) were all independently associated with PSM. TORS versus a non-robotic approach was not associated with PSM (23.9 % vs 20.4 %, p 0.358), respectively. Positive margins were independently associated with a worse OS than negative margins (HR 1.63, 95 % CI: 1.03-2.59). Adjuvant radiation therapy was associated with improved survival in high grade tumors with positive margins.
This study represents the largest review assessing risk factors for positive margins in OPSGM. Histologic type (adenoid cystic carcinoma), age, T4a tumor stage and treatment at a lower volume institution were all predictive of positive margins. With increasing use of TORS over the last decade, there does not appear to be a greater risk of positive margins using this modality in select patients.
N/A.
阳性手术切缘（PSM）与口咽涎腺恶性肿瘤（OPSGM）的生存预后较差相关，但现有文献仅限于小系列研究。我们的目的是利用国家癌症数据库（NCDB）确定 PSM 的风险因素，包括经口机器人手术（TORS）方法。
在 2010 年至 2017 年间，对接受切除术的 T1-T4a OPSGM 患者进行了 NCDB 检索。使用逻辑回归确定 PSM 的风险因素。使用 Kaplan-Meier 和 Cox 比例风险模型分析总生存期（OS）。
在 785 名患者中，有 165 名（21.0%）患者存在 PSM。年龄、T4a 期肿瘤（OR 2.00，95%置信区间[CI]：1.03-3.88）、腺样囊性癌（OR 2.02，95%CI：1.29-3.18）和在低容量机构治疗（OR 1.68，95%CI：1.09-2.59）均与 PSM 独立相关。TORS 与非机器人方法相比，与 PSM 无关（23.9%与 20.4%，p 0.358）。与阴性切缘相比，阳性切缘与更差的 OS 独立相关（HR 1.63，95%CI：1.03-2.59）。辅助放疗与高级别肿瘤阳性切缘的生存改善相关。
本研究是评估 OPSGM 中 PSM 风险因素的最大综述。组织学类型（腺样囊性癌）、年龄、T4a 期肿瘤和在低容量机构治疗都是阳性切缘的预测因素。在过去十年中，随着 TORS 的应用日益增多，在某些患者中，使用这种方式似乎没有更高的阳性切缘风险。
N/A。
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