Song X L, Li W P, Yang J Y, Zhang H K, Wang H, Xue K, Liu Q, Sun X C, Yu H M, Wang D H
Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor, Chinese Academy of Medical Sciences (2018RU003), Shanghai 200031, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Dec 7;57(12):1442-1449. doi: 10.3760/cma.j.cn115330-20210930-00646.
To investigate the feasibility of endoscopic salvage surgery for patients with rT2 recurrent nasopharyngeal carcinoma (rNPC) and to analyze their prognostic factors. The clinical data of 33 patients with rT2 rNPC who underwent endoscopic extended nasopharyngectomy in Eye & ENT Hospital Affiliated to Fudan University from January 2015 to July 2020 were analyzed, including 29 males (87.9%) and 4 females (12.1%), aging (51.7±10.6) years. The clinicopathological characteristics of these patients were recorded and analyzed, in terms of gender, sex, alcohol and cigarette use, interval between primary treatment to recurrence, adjuvant therapy, lymph node metastasis, internal carotid artery (ICA) invasion, necrosis, margin and reconstruction materials. Kaplan Meier analysis was used to plot the overall survival rate and progression free survival rate curve, Log-rank test was used to analyze the prognostic factors among patients, and multivariate Cox proportional hazards regression was used to determine the independent risk factors of tumor progression free survival. Among 33 patients with rT2 rNPC, the recurrence interval of 24 patients with rNPC after primary radiotherapy was more than 2 years. A total of 25 patients received primary radiotherapy and adjuvant chemotherapy at the same time. There were 6 cases with cervical lymph node metastasis, 12 cases with ICA invasion, 8 cases with positive surgical margin, 7 cases underwent ICA embolization before operation. A total of 18 cases underwent pedicled tissue flap repairment after operation, including 12 pedicled nasal septal mucosa flaps and 6 temporalis muscle flaps. The median follow-up time was 15 months. Five patients died because of disease progression (in 2 cases), post surgical ICA hemorrhage (in 1 case), liver metastasis (in 1 case) and dysphagia (in 1 case). The 1-year, 2-year and 3-year overall survival rates of all patients were 93.9%, 81.8% and 81.8%, respectively. The 1-year, 2-year and 3-year progression free survival rates were 74.7%, 59.7% and 40.9%, respectively. Log-rank statistical analysis showed that the positive surgical margin (=0.060) and recurrence interval (=0.151) were possibly related to the prognosis of rT2 rNPC. Multivariate Cox regression analysis showed that the positive surgical margin was an independent risk factor for patients with rT2 rNPC (=0.034). Nasopharynx hemorrhage occurred in 4 patients, skull base bone necrosis occurred in 2 patients, trismus occurred in 3 patients, and no obvious brain complications occurred in 7 patients with ICA embolization. Endoscopic salvage surgery for rT2 rNPC is a safe and effective surgical option, but the long-term effect still needs long-term follow-up in bulk cases.
探讨内镜挽救性手术治疗复发T2期鼻咽癌（rNPC）患者的可行性，并分析其预后因素。分析2015年1月至2020年7月在复旦大学附属眼耳鼻喉科医院接受内镜扩大鼻咽癌切除术的33例rT2期rNPC患者的临床资料，其中男性29例（87.9%），女性4例（12.1%），年龄（51.7±10.6）岁。记录并分析这些患者的临床病理特征，包括性别、烟酒使用情况、初次治疗至复发的间隔时间、辅助治疗、淋巴结转移、颈内动脉（ICA）侵犯、坏死、切缘及重建材料。采用Kaplan-Meier分析绘制总生存率和无进展生存率曲线，采用Log-rank检验分析患者的预后因素，采用多因素Cox比例风险回归分析确定肿瘤无进展生存的独立危险因素。33例rT2期rNPC患者中，24例rNPC患者初次放疗后的复发间隔超过2年。共有25例患者同时接受了初次放疗和辅助化疗。有6例发生颈部淋巴结转移，12例发生ICA侵犯，8例手术切缘阳性，7例术前接受了ICA栓塞。共有18例患者术后接受了带蒂组织瓣修复，其中带蒂鼻中隔黏膜瓣12例，颞肌瓣6例。中位随访时间为15个月。5例患者因疾病进展（2例）、术后ICA出血（1例）、肝转移（1例）和吞咽困难（1例）死亡。所有患者的1年、2年和3年总生存率分别为93.9%、81.8%和81.8%。1年、2年和3年无进展生存率分别为74.7%、59.7%和40.9%。Log-rank统计分析显示，手术切缘阳性（=0.060）和复发间隔（=0.151）可能与rT2期rNPC的预后有关。多因素Cox回归分析显示，手术切缘阳性是rT2期rNPC患者的独立危险因素（=0.034）。4例患者发生鼻咽出血，2例患者发生颅底骨坏死，3例患者发生张口受限，7例接受ICA栓塞的患者未出现明显脑部并发症。内镜挽救性手术治疗rT2期rNPC是一种安全有效的手术选择，但长期效果仍需大量病例的长期随访。
