经口机器人手术治疗T1-T2期口咽鳞状细胞癌的分析
Analysis of T1-T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery.
作者信息
Li Hui, Zhang Xing, Chen Wenkuan, Zhang Quan, Li Qiuli, Chen Shuwei, Yang Zhongyuan, Su Xuan, Yan Shida, Yang Ankui, Song Ming
机构信息
Collaborative Innovation Center for Cancer Medicine State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center Guangzhou China.
Department of Head and Neck Surgery Sun Yat-sen University Cancer Center Guangzhou China.
出版信息
Laryngoscope Investig Otolaryngol. 2023 Jan 10;8(1):103-112. doi: 10.1002/lio2.1005. eCollection 2023 Feb.
OBJECTIVE
Transoral robotic surgery (TORS) has become an effective treatment for early-stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)-positive and HPV-negative OPSCC in China.
METHODS
Patients with OPSCC of pT1-T2 stage who underwent TORS from March 2017 to December 2021 were analyzed.
RESULTS
A total of 83 patients (HPV-positive, = 25; HPV-negative, = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long-term tracheotomy. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV-positive group and HPV-negative group were 100% versus 84.3% ( = .07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence ( < .05).
CONCLUSION
Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1-T2 stage OPSCC treatment, regardless of HPV status.
LEVEL OF EVIDENCE
目的
经口机器人手术（TORS）已成为早期口咽鳞状细胞癌（OPSCC）的有效治疗方法。我们旨在分析TORS在中国治疗人乳头瘤病毒（HPV）阳性和HPV阴性OPSCC的临床安全性和疗效。
方法
分析2017年3月至2021年12月接受TORS治疗的pT1-T2期OPSCC患者。
结果
共纳入83例患者（HPV阳性，n = 25；HPV阴性，n = 58）。患者的中位年龄为57.0岁，男性71例。大多数原发肿瘤部位为腭扁桃体（52例，62.7%）和舌根（20例，24.1%）。3例患者切缘阳性。共有12例（14.5%）患者接受了气管切开术，气管切开套管的平均使用时间为9.4天，鼻胃管为14.5天。没有患者需要长期气管切开。83例患者的3年总生存率（OS）、无病生存率（DFS）和无复发生存率（RFS）分别为89.5%、80.1%和83.3%。HPV阳性组和HPV阴性组的3年OS分别为100%和84.3%（P = 0.07），而两组之间的DFS和RFS也无显著差异。在所有潜在危险因素的多因素cox回归分析中，吸烟是疾病复发的显著危险因素（P < 0.05）。
结论
无论HPV状态如何，经口机器人手术在T1-T2期OPSCC治疗中均取得了令人鼓舞的肿瘤学疗效和安全性。
证据级别
4级。
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