Canu L, Zanatta L, Sparano C, Santoro R, Mannelli G, Zamengo S, Jance B, Amore F, Ercolino T, Mannelli M, Maggi M, Rapizzi E
Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Endocrinology Unit, Careggi University Hospital, Florence, Italy.
Endocrine. 2025 May;88(2):607-615. doi: 10.1007/s12020-025-04167-1. Epub 2025 Jan 26.
To compare functional deficits associated to surgery with those caused by the growth of the head and neck paragangliomas (HNPGLs).
72 patients with HNPGLs were included. Patients were divided in group A (49 patients undergoing surgery) and group B (23 patients following a wait and see approach). Each patient was subjected to clinical evaluation and genetic testing. The presence of functional neurological deficits in speech or swallowing and quality of life were assessed via a dedicated otolaryngologist visit, three posted questionnaires (VHI, DHI, and MDADI), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35.
Thirty-four patients from group A (69.4%) and 18 from group B (78.2%) agreed to fill out the posted questionnaires. Eighteen patients from group A (36.7%) and 10 from group B (43.5%) underwent a dedicated otolaryngologist visit. A significant difference between group A and B was observed in the VHI (p = 0.001) and DHI scoring (p = 0.020), and at the otolaryngologist visit (mild neurological disabilities, p = 0.007). Patients with familial forms presented multiple HNPGLs (p = 0.011), multiple secreting lesions (p = 0.010) and underwent surgery more times for HNPGLs (p = 0.009) and for both HNPGLs and sympathetic PGLs (p = 0.015). ROC curve analysis suggests that surgery in carotid body tumors >34 mm may be more frequently associated with nerve injury.
The management of HNPGL patients remains challenging for clinicians. This preliminary study seems to suggest that surgery still represents the first choice for patients with small lesions. An accurate clinical evaluation is mandatory to avoid non-resolving surgery and possible neurovascular long-term complications.
比较头颈部副神经节瘤（HNPGLs）手术相关的功能缺陷与肿瘤生长所致的功能缺陷。
纳入72例HNPGLs患者。患者分为A组（49例行手术治疗）和B组（23例采取观察等待策略）。对每位患者进行临床评估和基因检测。通过专科耳鼻喉科医生会诊、三份邮寄问卷（VHI、DHI和MDADI）以及欧洲癌症研究与治疗组织生活质量问卷-H&N35评估言语或吞咽方面的功能性神经功能缺损情况及生活质量。
A组34例患者（69.4%）和B组18例患者（78.2%）同意填写邮寄问卷。A组18例患者（36.7%）和B组10例患者（43.5%）接受了专科耳鼻喉科医生会诊。A组和B组在VHI评分（p = 0.001）、DHI评分（p = 0.020）以及耳鼻喉科医生会诊时（轻度神经功能障碍，p = 0.007）存在显著差异。家族性形式的患者表现为多发HNPGLs（p = 0.011）、多发分泌性病变（p = 0.010），因HNPGLs接受手术的次数更多（p = 0.009）以及因HNPGLs和交感神经副神经节瘤均接受手术的次数更多（p = 0.015）。ROC曲线分析表明，颈动脉体瘤直径>34 mm时手术更常与神经损伤相关联。
对于临床医生而言，HNPGL患者的管理仍然具有挑战性。这项初步研究似乎表明，手术仍是小病灶患者的首选。必须进行准确的临床评估，以避免手术效果不佳及可能出现的神经血管长期并发症。
