Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Head Neck. 2024 Sep;46(9):2214-2222. doi: 10.1002/hed.27836. Epub 2024 Jun 20.
There are no large studies reporting oncological or survival outcomes for patients diagnosed with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC) via the ophthalmic nerve (V). Where orbital exenteration may be necessary for curative treatment, it is critical to have survival data with which the morbidity associated with surgical treatment can be justified. Furthermore, with the emerging treatment option of immunotherapy, current standard of care outcomes are needed to help guide future trial design and eventually changed management guidelines.
To determine the oncological and survival outcomes observed in patients with PNS of cSCC via V.
Retrospective analysis of prospectively maintained cohort of patients with PNS of cSCC via V1 treated in a tertiary Australian head and neck oncology/skull base referral center. Consecutive sample of 53 patients managed between March 1, 1999 and April 30, 2020. Follow-up closure date was September 1, 2021. Curative-intent surgery, curative-intent radiotherapy, or palliative care was undertaken. Endpoints included five-year overall, disease-specific, and disease-free survival from the date of treatment.
Five-year Kaplan-Meier overall survival was 61.9% (95% CI 46.2%-74.3%), with disease-specific survival of 74.6% (95% CI 58.8%-85.3%), and disease-free survival 62.1% (95% CI 46.5%-74.3%). Survival was superior in patients treated via surgery and adjuvant radiotherapy than in those receiving surgery alone or definitive radiotherapy. Survival was superior among patients with less advanced disease as assessed by the Williams zonal staging system; patients with Zone 1 disease had disease-specific survival of 94.1% at 5 years with 82.5% disease-free survival.
Five-year oncological and survival outcomes in this cohort were favorable. Superior survival was observed in patients treated with curative-intent surgery and adjuvant radiotherapy. Less extensive disease as delineated by the Williams zonal staging system was associated with improved survival.
Surgical resection with adjuvant radiotherapy confers favourable oncological and survival outcome in patients with V1 PNS, particularly with early disease limited to Zone 1.
目前尚无大样本研究报告通过眶上神经（V 神经）诊断的皮肤鳞状细胞癌（cSCC）发生神经周围播散（PNS）患者的肿瘤学或生存结局。对于需要根治性治疗的患者，可能需要进行眶内容剜除术，因此需要有生存数据来证明手术治疗相关的发病率是合理的。此外，随着免疫治疗这一新兴治疗选择的出现，需要当前的标准治疗结果来帮助指导未来的试验设计，并最终改变管理指南。
确定通过 V 神经诊断的 cSCC 患者发生 PNS 的肿瘤学和生存结局。
回顾性分析了在澳大利亚一家三级头颈肿瘤/颅底转诊中心接受治疗的 V1 神经 PNS 的连续 cSCC 患者的前瞻性队列。连续样本包括 53 名患者，他们在 1999 年 3 月 1 日至 2020 年 4 月 30 日期间接受了治疗。随访截止日期为 2021 年 9 月 1 日。进行了根治性手术、根治性放疗或姑息治疗。终点包括从治疗日期起的五年总生存率、疾病特异性生存率和无病生存率。
五年 Kaplan-Meier 总生存率为 61.9%（95%CI 46.2%-74.3%），疾病特异性生存率为 74.6%（95%CI 58.8%-85.3%），无病生存率为 62.1%（95%CI 46.5%-74.3%）。接受手术和辅助放疗治疗的患者比仅接受手术或根治性放疗的患者生存情况更好。根据威廉姆斯分区分期系统评估，疾病程度较轻的患者生存情况更好；1 区疾病患者 5 年疾病特异性生存率为 94.1%，无病生存率为 82.5%。
本队列的五年肿瘤学和生存结局良好。接受根治性手术和辅助放疗的患者生存情况更好。威廉姆斯分区分期系统划分的疾病范围较小与生存改善相关。
对于 V1 PNS 患者，手术切除加辅助放疗可带来良好的肿瘤学和生存结局，特别是对于早期疾病仅限于 1 区的患者。
