Salvage surgery in recurrent head and neck squamous cell carcinoma: Oncologic outcome and predictors of disease free survival
Salvage surgery in recurrent head and neck squamous cell carcinoma: Oncologic outcome and predictors of disease free survival
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DOI：
10.1016/j.oraloncology.2017.01.008
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发表时间：
2017-04-01
期刊：
影响因子：
4.8
通讯作者：
Schmitz, Sandra
中科院分区：
文献类型：
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作者：
Hamoir, Marc;Holvoet, Emma;Schmitz, Sandra
目的：复发性SCCHN的挽救性手术与不良结局相关。本研究的目的是更好地确定合适的手术候选人和那些在新的recurrence.Materials和方法的高风险：单中心回顾性分析109例接受挽救手术复发SCCHN。结果：无病期> 6个月[HR 0.53; p = 0.04]、年龄> 70岁[HR 0.26; p = 0.03]、初次放化疗[HR 2.39;与放疗相比，口咽[HR 5.46; p < 0.01]和下咽[HR 3.92; p = < 0.01]部位，与喉相比，初始III期[HR 7.10; p < 0.01]和IV期[HR 4.13; p < 0.01]，与I期相比，局部复发[HR 4.57; p < 0.01]，与局部复发相比。单变量分析还确定了DFS较差的重要术后预测因素，包括皮瓣重建[HR 3.44; p < 0.01]、术后并发症[HR 2.09; p = 0.01]、切缘阳性[HR 3.64; p < 0.01]和切缘闭合[HR 3.83; p < 0.01]。在多变量分析中，口咽部位[HR 3.98; p < 0.01]、初始III期[HR 5.93; p < 0.01]和局部复发[HR 2.93; p = 0.04]是DFS的独立术前预后因素。切缘阳性[HR 2.32; p = 0.04]、切缘闭合[HR 2.94; p = 0.02]、囊外扩散（ECS）[HR 4.04; p = 0.03]和术后并发症[HR 3.64; p < 0.01]是独立的术后预后因素。晚期原发性非喉肿瘤和局部复发的患者采用挽救性手术的成功率有限。由于切缘阳性和ECS患者复发的风险较高，因此应讨论辅助治疗。(C)2017爱思唯尔有限公司版权所有。
Objective: Salvage surgery in recurrent SCCHN is associated with poor outcomes. This study aimed to better identify suitable surgical candidates and those at high risk of new recurrence.Materials and methods: Single-center retrospective analysis of 109 patients undergoing salvage surgery for recurrent SCCHN. Univariate and multivariate analyses were used to identify prognostic factors affecting disease-free survival (DFS).Results: The following factors showed a significant impact on DFS: Disease-free interval > 6 months [HR 0.53; p = 0.04], age > 70 years [HR 0.26; p = 0.03], primary chemoradiotherapy [HR 2.39; p < 0.01] compared to radiotherapy, oropharynx [HR 5.46; p < 0.01] and hypopharynx [HR 3.92; p = < 0.01] sites, compared to larynx, initial stage III [HR 7.10; p < 0.01] and stage IV [HR 4.13; p < 0.01], compared to stage I, locoregional recurrence [HR 4.57; p < 0.01], compared to local recurrence. Univariate analysis also identified significant postoperative predictors of poor DFS including flap reconstruction [HR 3.44; p < 0.01], postoperative complications [HR 2.09; p = 0.01], positive margins [HR 3.64; p < 0.01] and close margins [HR 3.83; p < 0.01]. On multivariate analysis, oropharynx site [HR 3.98; p < 0.01], initial stage III [HR 5.93; p < 0.01] and locoregional recurrence [HR 2.93; p = 0.04] were independent preoperative prognostic factors for DFS. Positive margins [HR 2.32; p = 0.04], close margins [HR 2.94; p = 0.02], extracapsular spread (ECS) [HR 4.04; p = 0.03] and postoperative complications [HR 3.64; p < 0.01] were independent postoperative prognostic factors.Conclusions: Patients with advanced primary nonlaryngeal tumor and locoregional recurrence have limited success with salvage surgery. Because patients with positive margins and ECS are at high risk of relapse, adjuvant treatment should be discussed. (C) 2017 Elsevier Ltd. All rights reserved.