Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Sep;92(9):2299-2304. doi: 10.1111/ans.17908. Epub 2022 Jul 22.
To present an institution's experience and survival outcomes for patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) and perineural spread (PNS).
Retrospective study of patients with HNcSCC and PNS treated between January 2010 and August 2020 from the Sydney Head and Neck Cancer Institute database, Sydney, Australia; a high-volume, tertiary, academic head and neck centre. Patient demographics, primary site, involved cranial nerves, treatment modality, loco-regional failure and survival data were obtained.
Forty-five patients were identified, of which 32 patients were male (71%). Mean age at diagnosis was 68.7 years (range 43-90). Median follow-up was 16.1 months (range 1-107). The trigeminal nerve was most frequently involved (n = 30, 66.6%) followed by facial nerve (n = 13, 28.9%). Most patients underwent surgery followed by radiotherapy (n = 33, 73%) and eight received definitive radiotherapy. The median overall survival (OS) was 4.5 years (95% CI 3.71-5.38), median disease-specific survival 5.1 years (95% CI 4.21-5.97) and median disease-free survival (DFS) was 1.7 years (95% CI 1.11-2.22). The estimated 5-year OS and DFS were 45% and 25%, respectively. Patients treated with surgery and adjuvant radiotherapy with a clear proximal nerve margin had favourable DFS (P = 0.035) and trended towards better OS (P = 0.134) compared with patients with an involved nerve margin. Patients treated surgically with involved proximal nerve margins had similar outcomes compared with patients with treated definitive radiotherapy (HR 0.80, 95% CI 0.29-2.22, P = 0.664).
The likelihood of achieving a clear proximal nerve margin should be a strong consideration in the selection of appropriate patients for primary surgery.
介绍一家机构治疗头颈部皮肤鳞状细胞癌（HNcSCC）和神经周围播散（PNS）患者的经验和生存结果。
对 2010 年 1 月至 2020 年 8 月期间来自澳大利亚悉尼头颈部癌症研究所数据库的 HNcSCC 和 PNS 患者进行回顾性研究；该研究所是一家高容量的三级学术头颈部中心。获取患者的人口统计学数据、原发部位、受累颅神经、治疗方式、局部区域复发和生存数据。
共确定了 45 例患者，其中 32 例为男性（71%）。诊断时的平均年龄为 68.7 岁（范围 43-90 岁）。中位随访时间为 16.1 个月（范围 1-107 个月）。最常受累的是三叉神经（n=30，66.6%），其次是面神经（n=13，28.9%）。大多数患者接受了手术联合放疗（n=33，73%），8 例患者接受了根治性放疗。中位总生存期（OS）为 4.5 年（95%CI 3.71-5.38），中位疾病特异性生存期为 5.1 年（95%CI 4.21-5.97），中位无病生存期（DFS）为 1.7 年（95%CI 1.11-2.22）。估计 5 年 OS 和 DFS 分别为 45%和 25%。与神经受累边缘患者相比，接受手术和辅助放疗且近端神经切缘清晰的患者具有更好的 DFS（P=0.035）和 OS（P=0.134）趋势。接受手术治疗且近端神经受累的患者与接受根治性放疗的患者相比，结局相似（HR 0.80，95%CI 0.29-2.22，P=0.664）。
在选择合适的患者进行原发性手术时，应充分考虑是否能获得清晰的近端神经切缘。
