目的:大多数关于HPV阳性口咽鳞状细胞癌(HPV-OPC)的经口机器人手术(TORS)文献来源于大量三级医疗中心。这项研究旨在描述退伍军人健康管理局患者的长期复发和生存结果。
方法:使用美国退伍军人事务数据库,我们确定了2010年1月至2016年12月期间接受TORS治疗的HPV-OPC患者.患者按风险类别进行分层:低(0-1个转移性淋巴结,负边距),中间(接近利润率,2-4个转移性淋巴结,淋巴血管或神经周浸润,pT3-pT4肿瘤),或高(正利润率,结外延伸(ENE),和/或≥5个转移性淋巴结)。主要结果包括总生存期(OS),疾病特异性生存率(DSS),和无复发生存率(RFS)。
结果:该队列包括161例患者,其中29例(18%)为低风险,45(28%)中等风险,和87(54%)高风险。41%的淋巴结阳性病例存在ENE,24%的切缘阳性。中位随访时间为5.6年(95%CI,3.0-9.3)。5年DSS为低,中间,高危人群是:100%,90.0%(95%CI,75.4-96.1%),和88.7%(95%CI,78.3-94.2%)。单变量分析与不良DSS相关的病理特征包括pT3-T4肿瘤(HR3.81,95%CI,1.31-11;p=0.01),≥5个转移性淋巴结(HR3.41,95%CI,1.20-11;p=0.02),和ENE(HR3.53,95%CI,1.06-12;p=0.04)。在更晚期的肿瘤中观察到更高的5年累积复发发生率(pT3-T4,33%[95%CI,14-54%]对pT1-T2,13%[95%CI,8-19%];p=0.01)。
结论:在这项全国性的研究中,在退伍军人事务医学中心接受TORS辅助治疗的HPV-OPC患者表现出与高容量学术中心和临床试验中报道的患者相当的良好生存结局.
方法:4喉镜,2023年。
Most transoral robotic surgery (TORS) literature for HPV-positive oropharyngeal squamous cell carcinoma (HPV-OPC) derives from high-volume tertiary-care centers. This study aims to describe long-term recurrence and survival outcomes among Veterans Health Administration patients.
Using the US Veterans Affairs database, we identified patients with HPV-OPC treated with TORS between January 2010 and December 2016. Patients were stratified in risk categories: low (0-1 metastatic nodes, negative margins), intermediate (close margins, 2-4 metastatic nodes, lymphovascular or perineural invasion, pT3-pT4 tumor), or high (positive margins, extranodal extension (ENE), and/or ≥5 metastatic nodes). Primary outcomes included overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).
The cohort included 161 patients of which 29 (18%) were low-risk, 45 (28%) intermediate-risk, and 87 (54%) high-risk. ENE was present in 41% of node-positive cases and 24% had positive margins. Median follow-up was 5.6 years (95% CI, 3.0-9.3). The 5-year DSS for low, intermediate, and high-risk groups were: 100%, 90.0% (95% CI, 75.4-96.1%), and 88.7% (95% CI, 78.3-94.2%). Pathologic features associated with poor DSS on univariable analysis included pT3-T4 tumors (HR 3.81, 95% CI, 1.31-11; p = 0.01), ≥5 metastatic nodes (HR 3.41, 95% CI, 1.20-11; p = 0.02), and ENE (HR 3.53, 95% CI, 1.06-12; p = 0.04). Higher 5-year cumulative incidences of recurrence were observed in more advanced tumors (pT3-T4, 33% [95% CI, 14-54%] versus pT1-T2, 13% [95% CI, 8-19%]; p = 0.01).
In this nationwide study, patients with HPV-OPC treated with TORS followed by adjuvant therapy at Veterans Affairs Medical Centers demonstrated favorable survival outcomes comparable to those reported in high-volume academic centers and clinical trials.
4 Laryngoscope, 134:207-214, 2024.