经口激光微创手术治疗 368 例口咽癌患者。

Transoral laser microsurgery for treatment of oropharyngeal cancer in 368 patients.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.

Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany.

出版信息

Head Neck. 2019 Sep;41(9):3144-3158. doi: 10.1002/hed.25806. Epub 2019 Jun 10.

DOI:10.1002/hed.25806

PMID:31179614

Abstract

BACKGROUND

Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept.

METHODS

A total of 368 patients with oropharyngeal squamous cell carcinoma (pT1-4, pN0-2, M0) underwent TLM +/- neck dissection (85%), +/- (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%).

RESULTS

Five-year Kaplan-Meier estimates for local control were 83.5% for pT1, 74.1% for pT2, 77.3% for pT3, and 76.0% for pT4a tumors. Five-year estimates of overall, disease-specific, and recurrence-free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16-positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency.

CONCLUSION

Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced-stage oropharyngeal cancer.

摘要

背景

通过多模式治疗方案，我们研究了经口激光微创手术（TLM）作为原发治疗用于口咽鳞癌的肿瘤学和功能学结果。

方法

368 例口咽鳞癌（pT1-4、pN0-2、M0）患者接受 TLM +/-颈清扫术（85%）， +/-（放）化疗（57%）。大多数患者为 III 期和 IVa 期（79%）晚期疾病。

结果

TLM 治疗的局部控制的 5 年 Kaplan-Meier 估计值为：pT1 为 83.5%，pT2 为 74.1%，pT3 为 77.3%，pT4a 为 76.0%。I 期、II 期、III 期和 IVa 期的总生存率、疾病特异性生存率和无复发生存率的 5 年估计值分别为 76.0%、92.8%和 69.1%；71.1%、85.7%和 49.6%；61.7%、72.5%和 58.8%；57.3%、73.7%和 63.9%。术后（放）化疗可改善晚期疾病的预后。p16 阳性肿瘤具有更好的生存估计值。总体而言，93.5%的患者能够维持常规的口腔营养，无需依赖喂养管。