METHODS: This was a retrospective 30-year review using STROBE guidelines at an academic, tertiary referral center. A total of 294 patients with T1-2 SCC of the lateral oropharynx were reviewed. Only 19% of patients were never-smokers, suggesting a predominantly HPV-negative population. All patients had transoral mandibular preservation surgery. Follow-up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and postoperative radiation therapy (31.6%) Local control, survival, and functional endpoints, as well as the consequences of local recurrence, were analyzed.
RESULTS: The 10-year local disease control was 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% local control rate. The overall 10-year survival was 50%. Mortality was related to metachronous second primary cancer (MSPC) (29.2%), medical comorbidities (25.7%), uncontrolled local recurrence (10%), and complications following transoral resection (4.2%). In multivariate analysis, the development of an MSPC significantly increased (p < 0.005) the risk of death. Overall, 95.2% of patients achieved mandibular preservation. However, gastrostomy and tracheostomy dependence occurred in 1% and 0.3% of cases, respectively.
CONCLUSIONS: For a patient population with a significant percentage of tobacco-associated oropharyngeal cancer (OPC), transoral surgery was associated with long-term minimal postoperative complications and a high rate of local control. MSPC was the main cause of death during the first 10 postoperative years. Such long-term figures support transoral surgery as an effective first-line treatment for early-stage predominantly tobacco-related OPC.
METHODS: 4 Laryngoscope, 2024.
方法:这是一项30年的回顾性审查,使用STROBE指南,三级转诊中心。共对294例口咽侧T1-2SCC患者进行了回顾。只有19%的患者从不吸烟,提示主要是HPV阴性人群。所有患者均经口下颌骨保存手术。后续治疗包括颈清扫术(76.5%),诱导化疗(57.8%),和术后放射治疗(31.6%)局部控制,生存,和功能端点,以及局部复发的后果,进行了分析。
结果:10年局部疾病控制率为88.3%。50%的病例挽救了局部复发,导致整体94.5%的局部控制率。10年总生存率为50%。死亡率与异时第二原发癌(MSPC)有关(29.2%),医疗合并症(25.7%),不受控制的局部复发(10%),经口切除术后的并发症(4.2%)。在多变量分析中,MSPC的发展显着增加(p<0.005)死亡风险。总的来说,95.2%的患者实现了下颌骨保存。然而,1%和0.3%的病例发生胃造口术和气管造口术依赖,分别。
结论:对于具有显著百分比的烟草相关口咽癌(OPC)的患者群体,经口手术长期术后并发症少,局部控制率高.MSPC是术后前10年的主要死亡原因。这些长期数据支持经口手术作为早期主要与烟草相关的OPC的有效一线治疗。
方法:4喉镜,2024.