Murray-Douglass Alexander, Crawford Lachlan, Hunt Justin, Dunn Darryl, Hughes Brett G M, Lin Charles, Fox Carly
Department of Plastic and Reconstructive Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Ann Surg Oncol. 2025 Apr;32(4):2725-2731. doi: 10.1245/s10434-024-16854-w. Epub 2025 Jan 13.
Locally advanced periorbital cutaneous squamous cell carcinoma (cSCC) may require orbital exenteration, which is highly morbid. As immunotherapy develops, orbit preservation may become widespread, and data benchmarking survival with current standard-of-care surgery and radiotherapy are essential to the integration of this emerging method into modern treatment paradigms. This study aimed to determine the survival of patients after orbital exenteration for cSCC and investigate contributing factors. It was hypothesized that postoperative radiotherapy would be associated with improved survival.
This was a retrospective cohort study of patients with T3 and T4 cSCC undergoing orbital exenteration. Survival analysis was performed using Cox proportional hazards.
The study enrolled 40 patients with a median age of 61.5 years who met the criteria. None of the patients had received preoperative radiotherapy. Age (hazard ratio [HR], 1.09; p = 0.019) and residual disease (HR, 9.00; p = 0.003) were associated with worse survival. Postoperative radiotherapy (HR, 0.003; p < 0.001) was associated with improved survival. Perineural, lymphovascular, and bony invasion and T and N stage were not associated with survival. Survival with postoperative radiotherapy was 94 % at 1 year, 87 % at 2 years, and 84 % at 5 years.
The oncologic outcomes of orbital exenteration with postoperative radiotherapy for locally advanced head and neck cSCC are good. However, amelioration of the morbidity caused by resection of the eye would be ideal. Data to support immunotherapy as a sole therapy are currently limited, but a combination of neoadjuvant immunotherapy and surgical treatment may facilitate orbit-preserving treatment in the future.
局部晚期眶周皮肤鳞状细胞癌（cSCC）可能需要行眶内容摘除术，该手术具有较高的致残性。随着免疫治疗的发展，保留眼眶可能会变得普遍，而将这种新兴方法纳入现代治疗模式时，以当前的标准治疗手术和放疗为基准的生存数据至关重要。本研究旨在确定cSCC患者行眶内容摘除术后的生存率，并调查相关影响因素。研究假设术后放疗与生存率提高相关。
这是一项对接受眶内容摘除术的T3和T4期cSCC患者的回顾性队列研究。采用Cox比例风险模型进行生存分析。
该研究纳入了40例符合标准的患者，中位年龄为61.5岁。所有患者均未接受术前放疗。年龄（风险比[HR]，1.09；p = 0.019）和残留病灶（HR，9.00；p = 0.003）与较差的生存率相关。术后放疗（HR，0.003；p < 0.001）与生存率提高相关。神经周围、淋巴管和骨侵犯以及T和N分期与生存率无关。术后放疗患者的1年生存率为94%，2年生存率为87%，5年生存率为84%。
局部晚期头颈部cSCC患者行眶内容摘除术后放疗的肿瘤学结局良好。然而，改善因眼球切除所致的致残情况将是理想的。目前支持免疫治疗作为单一疗法的数据有限，但新辅助免疫治疗与手术治疗相结合可能会在未来促进保留眼眶的治疗。
