Impact of Surgical Resection on Survival in Patients With Advanced Head and Neck Cancer Involving the Carotid Artery
Impact of Surgical Resection on Survival in Patients With Advanced Head and Neck Cancer Involving the Carotid Artery
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DOI：
10.1001/jamaoto.2013.4917
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发表时间：
2013-11-01
影响因子：
7.8
通讯作者：
Khan, Mumtaz J.
中科院分区：
文献类型：
--
作者：
Manzoor, Nauman F.;Russell, Jonathon O.;Khan, Mumtaz J.
目的评估采用不同治疗策略的晚期颈动脉鳞状细胞癌患者的生存结果。设计、背景和参与者2005年至2012年在三级护理中心对44例颈动脉鳞状细胞癌患者进行了回顾性研究。放射科医生对外科手术的结果视而不见。介入手术加或不加放疗，以及明确的放化疗。主要结果和衡量总存活率以及局部和远距离失败率。结果44例患者中，35例(80%)有治疗意图，包括手术加或不加辅助治疗(n=27[61%])或确定性放化疗(n=8[18%])，9例(21%)采用姑息性治疗。与姑息性治疗组(中位生存期3.6个月)相比，接受根治性治疗的患者总存活率(中位生存期13.5个月)有所提高(P=.001)。在有治疗意图的患者中，与复发或持续性疾病患者(n=21[60%])相比，以前未治疗疾病的患者(n=14[40%])的结果有所改善，中位生存期分别为38.7个月和9.6个月(P=.008)。患者采用3种不同的治疗策略(即颈动脉切除加或不加再转移)(n=6[17%])、根治性剥离加或不加辅助治疗(n=21[60%])和确定性放化疗(n=8[23%])。有治疗意向的亚组患者的生存结果无显著差异(P=.47)。当头部和颈部放射科医生以盲法回顾(n=30)时，介入前影像对侵犯颈动脉的癌症可切除性的阳性预测值为72.7%。在受累于颈动脉近周缘(>；270度)且颈动脉狭窄的病例中，有3例是不能切除的(n=3)。结论和相关性：累及颈动脉的晚期头颈癌在大多数患者中可以达到治疗的目的，取得良好的效果。如果疾病负担值得，可以使用一种积极的方法，包括切除颈动脉或不切除颈动脉再转移，而不会显著增加并发症。
IMPORTANCE The present study addresses the survival benefit of aggressive surgical treatment of head and neck cancer involving the carotid artery.OBJECTIVE To assess survival outcomes in patients treated for advanced squamous cell carcinoma involving the carotid artery using different treatment strategies.DESIGN, SETTING, AND PARTICIPANTS Retrospective study at a tertiary care center of 44 consecutive patients with squamous cell carcinoma involving the carotid artery from 2005 to 2012 with a median follow-up of 12 months. The radiologist was blinded to the outcome of surgical procedures.INTERVENTIONS Surgery with or without radiotherapy, and definitive chemoradiation.MAIN OUTCOMES AND MEASURES Overall survival and rates of locoregional and distant failures. The hypothesis was formulated before data collection.RESULTS Of 44 patients, 35 (80%) were treated with curative intent with surgery with or without adjuvant therapy (n = 27 [61%]) or definitive chemoradiation therapy (n = 8 [18%]), while 9 patients (21%) were treated in a palliative fashion. Patients treated with curative intent had improved overall survival (median survival, 13.5 months) compared with the palliative group (median survival, 3.6 months) (P = .001). Of patients treated with curative intent, those with previously untreated disease (n = 14 [40%]) had an improved outcome relative to patients with recurrent or persistent disease (n = 21 [60%]), with median survival of 38.7 and 9.6 months, respectively (P = .008). Patients were treated with curative intent using 3 different treatment strategies (ie, carotid artery resection with or without reanastamosis) (n = 6 [17%]), curative peeling with or without adjuvant therapy (n = 21 [60%]), and definitive chemoradiation therapy (n = 8 [23%]). Survival outcome was not significantly different between subgroups treated with curative intention (P = .47). When reviewed by a head and neck radiologist in a blinded fashion (n = 30), preintervention imaging had a positive predictive value of 72.7% for resectability of cancer involving the carotid artery. In cases with almost circumferential involvement (>270 degrees) and narrowing of the carotid artery, the disease was unresectable (n = 3).CONCLUSIONS AND RELEVANCE Advanced head and neck cancer involving the carotid artery can be treated with curative intent with favorable results in most patients. If disease burden merits, an aggressive approach involving resection with or without reanastamosis of the carotid artery can be used without significant added morbidity.