Zhang Lirui, Xu Qiaoshi, Liu Huan, Li Bo, Wang Hao, Liu Chang, Li Jinzhong, Yang Bin, Qin Lizheng, Han Zhengxue, Feng Zhien
Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2022 Nov 1;12:1017630. doi: 10.3389/fonc.2022.1017630. eCollection 2022.
The prognosis, choice of reconstruction and the quality of life (QOL) after salvage surgery (SS) for extensively locoregional recurrent/metastatic head and neck cancer (R/M HNC) is an important issue, but there are few reports at present.
We analyzed extensively locoregional R/M HNC patients from March 1, 2015, to December 31, 2021 who underwent SS with latissimus dorsi or pectoralis major musculocutaneous flaps. QOL were accessed using QLQ-H&N35 and UW-QOL questionnaire. Wilcoxon signed-rank test was used to compare difference between pre- and post-QOL and Kaplan-Meier curves were used in estimate overall survival (OS) and disease-free survival (DFS). The literature review summarized recent 10 years clinical trials of nonoperative treatment in R/M head and neck cancer.
1362 patients were identified and 25 patients were analyzed after screened. Median age at surgery was 59 years (range 43-77), 15/25(60%) were male and 22/25(88%) chose latissimus dorsi flap. Better mean pain score after applying massive soft tissue flaps revealed relief of severe pain(p<0.001) which strongly associated with improvement of QOL. The improved mean overall QOL score after surgery revealed a better QOL(p<0.001). As of June 1, 2022, 11/25 (44%) of the patients were alive. The 1-year, 2-year OS after SS was 58.4% and 37.2%, while the 1-year, 2-year DFS was 26.2% and 20.9%. The median OS of our study was better than nonoperative treatment of 11 included clinical trials.
R/M HNC patients underwent SS can obtain survival benefit. The application of massive soft tissue flap in SS could significantly enhance the QOL for patients with extensively locoregional R/M HNC, especially by relieving severe pain.
对于广泛局部复发/转移的头颈癌（R/M HNC）患者，挽救性手术（SS）后的预后、重建方式选择及生活质量（QOL）是一个重要问题，但目前相关报道较少。
我们分析了2015年3月1日至2021年12月31日期间接受背阔肌或胸大肌肌皮瓣挽救性手术的广泛局部R/M HNC患者。使用QLQ-H&N35和UW-QOL问卷评估生活质量。采用Wilcoxon符号秩检验比较生活质量前后差异，并用Kaplan-Meier曲线评估总生存期（OS）和无病生存期（DFS）。文献综述总结了近10年R/M头颈癌非手术治疗的临床试验。
共识别出1362例患者，筛选后分析了25例患者。手术时的中位年龄为59岁（范围43 - 77岁），15/25（60%）为男性，22/25（88%）选择背阔肌瓣。应用大量软组织瓣后平均疼痛评分改善，显示严重疼痛得到缓解（p<0.001），这与生活质量的改善密切相关。术后平均总体生活质量评分提高，显示生活质量更好（p<0.001）。截至2022年6月1日, 11/25（44%）的患者存活。挽救性手术后1年、2年总生存率分别为58.4%和37.2%，1年、2年无病生存率分别为26.2%和20.9%。我们研究的中位总生存期优于纳入的11项非手术治疗临床试验。
接受挽救性手术的R/M HNC患者可获得生存获益。在挽救性手术中应用大量软组织瓣可显著提高广泛局部R/M HNC患者的生活质量，尤其是通过缓解严重疼痛。
