Zittel Sven, Moratin Julius, Awounvo Sinclair, Rückschloß Thomas, Freier Kolja, Ristow Oliver, Engel Michael, Hoffmann Jürgen, Freudlsperger Christian, Horn Dominik
Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany.
J Clin Med. 2023 Oct 18;12(20):6602. doi: 10.3390/jcm12206602.
Patients with recurrent oral squamous cell carcinoma (OSCC) have limited treatment options. Salvage surgery offers potential curative therapy. The need for extensive ablative surgery together with microvascular reconstruction implies invasive and painful treatment with questionable functional outcome. To address the impact of salvage surgery on the health-related quality of life (HRQoL) of patients suffering from recurrent OSCC, a multi-center prospective analysis was initiated.
Patients with recurrent OSCC from 2015 to 2022 at two German cancer centers were included. Interdisciplinary tumor board decisions determined surgery as the only curative treatment modality. HRQoL, was assessed via a EORTC questionnaire (European Organization for Research and Treatment of Cancer-EORTC: QLQ-C30 and QLQ-H&N35) in dependence of the recurrent tumor stage. Patients completed the questionnaires once before surgery (baseline) and then every 3 months during follow-up or up to the end of treatment.
In total, 55 patients were included. The mean follow-up period was 26.7 ± 19.3 months. Global health status showed superior mean scores after 12 months (60.83 ± 22.58) compared to baseline (53.33 ± 26.41) in stage 1 and 2 recurrent tumors. In advanced recurrent tumors' mean scores for global health showed only minor positive differences after 12 months (55.13 ± 22.7) compared to baseline (53.2 ± 25.58). In terms of the mouth pain, mean scores were lower after salvage surgery in small recurrent tumors after 12 months (20.37 ± 17.73) compared to baseline (41.67 ± 33.07; Wilcoxon two-sample signed-rank test = 0.028). In advanced recurrent tumors, a significant reduction in mean scores was detected 3 months after salvage surgery (29.7 ± 22.94) compared to baseline (47.76 ± 25.77; Wilcoxon two-sample signed-rank test = 0.003). Up to 12 months, swallowing function was evaluated inferior compared to baseline independent of tumor stage (Mean score recurrent stage I/II: 12-months 48.15 ± 27.57, baseline 28.7 ± 22.87; stage III/IV: 12-months 49.36.42 ± 27.53; baseline 30.13 ± 26.25).
Improved HRQoL could be obtained in advanced recurrent OSCC after salvage surgery despite reduced swallowing function. In small recurrent tumors, overall, HRQoL was superior to baseline. Salvage surgery positively affected pain burden. For advanced recurrent tumors, important pain relieve could be observed as soon as 3 months after surgery.
复发性口腔鳞状细胞癌（OSCC）患者的治疗选择有限。挽救性手术提供了潜在的治愈性治疗方法。广泛的切除手术以及微血管重建的需求意味着这种治疗具有侵入性且痛苦，功能预后也存在疑问。为了探讨挽救性手术对复发性OSCC患者健康相关生活质量（HRQoL）的影响，启动了一项多中心前瞻性分析。
纳入2015年至2022年在两个德国癌症中心就诊的复发性OSCC患者。跨学科肿瘤委员会的决定将手术确定为唯一的治愈性治疗方式。根据复发性肿瘤分期，通过欧洲癌症研究与治疗组织（EORTC）问卷（EORTC：QLQ-C30和QLQ-H&N35）评估HRQoL。患者在手术前（基线）完成一次问卷，然后在随访期间每3个月完成一次问卷，直至治疗结束。
共纳入55例患者。平均随访期为26.7±19.3个月。在1期和2期复发性肿瘤中，与基线（53.33±26.41）相比，12个月后的总体健康状况平均得分更高（60.83±22.58）。在晚期复发性肿瘤中，与基线（53.2±25.58）相比，12个月后的总体健康平均得分仅显示出微小的正向差异（55.13±22.7）。就口腔疼痛而言，小复发性肿瘤在挽救性手术后12个月时的平均得分（20.37±17.73）低于基线（41.67±33.07；Wilcoxon双样本符号秩检验=0.028）。在晚期复发性肿瘤中，与基线（47.76±25.77）相比，挽救性手术后3个月时平均得分显著降低（29.7±22.94；Wilcoxon双样本符号秩检验=0.003）。直至12个月，无论肿瘤分期如何，吞咽功能评估均低于基线（复发性I/II期平均得分：12个月时48.15±27.57，基线时28.7±22.87；III/IV期：12个月时49.36.42±27.53；基线时30.13±26.25）。
尽管吞咽功能有所下降，但挽救性手术后晚期复发性OSCC患者的HRQoL仍可得到改善。总体而言，在小复发性肿瘤中，HRQoL优于基线。挽救性手术对疼痛负担有积极影响。对于晚期复发性肿瘤，术后3个月即可观察到明显的疼痛缓解。
