Roman Kelsey M, Nguyen Cecilia, Torabi Sina J, Berger Michael H, Kuan Edward C, Tjoa Tjoson, Haidar Yarah M
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
Am J Otolaryngol. 2024 Jan-Feb;45(1):104060. doi: 10.1016/j.amjoto.2023.104060. Epub 2023 Sep 21.
This study was designed to assess trends in and outcomes associated with TORS-treated HNCUP using a large national database.
HPV+ oropharyngeal HNCUPs were isolated from the 2004-2017 National Cancer Database. Overall survival (OS) was assessed, with patients stratified by 1) use of TORS and 2) whether the occult tumor was ultimately located. Demographic and oncologic predictors of survival were evaluated on regression.
The cohort contained 284,734 cases, of which 8336 were HNCUPs. HNCUPs represented 2.49 % of all HNSCC in 2010 versus 3.13 % in 2017. 3897 (46.7 %) of these unknown primaries were ultimately identified. The proportion of cases treated with TORS increased from 6.9 % in 2010 to 18.1 % in 2017 (p < 0.001). Kaplan-Meier analysis of 2991 HPV+ oropharyngeal HNCUPs demonstrated higher 5-year overall survival (OS) for patients treated with robotic surgery versus no robotic surgery (95.4 % ± 1.7 % standard error [SE] versus 84.0 % ± 0.9 % SE; p < 0.001). Patients with primary tumors identified during treatment had improved OS compared to those whose tumors were not located (5-year OS was 90.5 % ± 0.9 % SE and 77.3 % ± 1.5 % SE, respectively; p < 0.001). For patients in which the primary tumor was found, those who received robotic surgery survived longer than those who did not (96.5 % ± 1.4 % SE versus 89.1 % ± 1.0 % SE 5-year OS; p < 0.001). The relationship between TORS and OS remained significant on Cox regression controlling for confounders.
Use of TORS in the workup for HPV+ HNCUP is associated with higher rates of tumor identification and improved OS.
本研究旨在利用一个大型国家数据库评估经口机器人手术（TORS）治疗的未知原发灶头颈部癌（HNCUP）的趋势及相关结果。
从2004 - 2017年国家癌症数据库中分离出HPV阳性的口咽HNCUP病例。评估总生存期（OS），患者按以下因素分层：1）是否使用TORS；2）隐匿性肿瘤最终是否被定位。通过回归分析评估生存的人口统计学和肿瘤学预测因素。
该队列包含284,734例病例，其中8336例为HNCUP。2010年HNCUP占所有头颈部鳞状细胞癌（HNSCC）的2.49%，而2017年为3.13%。这些未知原发灶中，3897例（46.7%）最终被确定。接受TORS治疗的病例比例从2010年的6.9%增加到2017年的18.1%（p < 0.001）。对2991例HPV阳性口咽HNCUP进行的Kaplan - Meier分析显示，接受机器人手术的患者5年总生存期（OS）高于未接受机器人手术的患者（95.4% ± 1.7%标准误[SE]对84.0% ± 0.9% SE；p < 0.001）。与肿瘤未被定位的患者相比，治疗期间发现原发肿瘤的患者OS有所改善（5年OS分别为90.5% ± 0.9% SE和77.3% ± 1.5% SE；p < 0.001）。对于原发肿瘤被发现的患者，接受机器人手术的患者比未接受机器人手术的患者存活时间更长（5年OS为96.5% ± 1.4% SE对89.1% ± 1.0% SE；p < 0.001）。在控制混杂因素的Cox回归分析中，TORS与OS之间的关系仍然显著。
在HPV阳性HNCUP的检查中使用TORS与更高的肿瘤识别率和改善的OS相关。
