Validation of the risk factors for primary control of early T-stage laryngeal, oropharyngeal, and hypopharyngeal squamous cell carcinoma by transoral surgery: a prospective observational study
Validation of the risk factors for primary control of early T-stage laryngeal, oropharyngeal, and hypopharyngeal squamous cell carcinoma by transoral surgery: a prospective observational study
复制标题
DOI：
10.1007/s10147-021-01992-y
复制
发表时间：
2021-07-21
影响因子：
3.3
通讯作者：
Oridate，Nobuhiko
中科院分区：
文献类型：
--
作者：
Nishimura，Goshi;Sano，Daisuke;Oridate，Nobuhiko
背景我们先前已经确定了经口手术（TOS）不能充分控制早期T期头颈癌的以下危险因素：（1）增强CT（CT）显示肿瘤厚度> 7 mm，（2）病理检查分化差。随后，我们使用了不同的患者队列，以验证这些因素的有用性，在确定需要适应的TOS.Study settingA前瞻性观察studyMethodsPatients谁收到TOS作为一个明确的治疗2016年4月1日和2020年9月30日之间的。计算与上述危险因素相关的一级控制率（单用TOS和单独用TOS）。评价了总体（O）、无复发（RF）和无疾病（DF）生存期（S）结局。结果肿瘤厚度> 7 mm的患者单次TOS不完全切除的风险高2.88倍[95%可信区间（CI）1.01-8.51]，而病理学评估显示分化差的患者单用TOS控制不充分的风险高13.14倍（95%CI 3.66-47.14）。3年OS、RFS和DFS率分别为99%、83%和63%。同时存在两种危险因素的患者，（95%CI 4.99-1732.00）单独使用TOS的不完全初级控制风险较高。结论在早期喉、口咽和下咽鳞状细胞癌患者中，单独使用TOS的初级控制可能无法在同时具有两种风险因素的患者中实现，即，增强CT测量肿瘤厚度> 7 mm，病理检查分化差。
BackgroundWe had previously identified the following risk factors for insufficient control of early T-stage head and neck cancer by transoral surgery (TOS): (1) tumor thickness > 7 mm on enhanced computed tomography (CT), and (2) poor differentiation in pathological examination. We subsequently used a different patient cohort to validate the usefulness of these factors in determining the need for adaptation of TOS.Study settingA prospective observational studyMethodsPatients who received TOS as a definitive treatment between April 1, 2016 and September 30, 2020 were included. Primary control rates (by single TOS and TOS alone) in relation to the above-mentioned risk factors were calculated. Overall (O), recurrence-free (RF), and disease-free (DF) survival (S) outcomes were evaluated. A combination analysis based on the number of risk factors was also performed.ResultsPatients with tumor thickness > 7 mm had a 2.88-fold [95% confidence interval (CI) 1.01–8.51] higher risk of incomplete primary resection by single TOS, while patients who showed poor differentiation on pathological assessments had a 13.14-fold (95% CI 3.66–47.14) higher risk of insufficient primary control by TOS alone. The 3 year OS, RFS, and DFS rates were 99%, 83%, and 63%, respectively. Patients with both risk factors had a 93.00-fold (95% CI 4.99–1732.00) higher risk of incomplete primary control by TOS alone.ConclusionsAmong patients with early-stage laryngeal, oropharyngeal, and hypopharyngeal squamous cell carcinoma, primary control by TOS alone may not be achieved in patients with both risk factors, that is, tumor thickness > 7 mm as measured by enhanced CT and poor differentiation on pathological examination.