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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and prognostic factors.
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Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and prognostic factors.

机译：鼻咽癌切除治疗复发性鼻咽癌：回顾31例患者和预后因素。

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OBJECTIVES/HYPOTHESIS Nasopharyngectomy is a well-established treatment option for recurrent nasopharyngeal carcinoma. Over a period of 4 years and 3 months, in a total of 43 patients, 45 nasopharyngectomies were performed. Thirty-one patients with follow-up ranging from 12 to 58 months were studied. Twenty-two patients (58%) survived; of these, 18 patients (82%) remained disease free. All patients who developed repeat recurrence or died (n = 12) had a high recurrent T-stage tumor, skull base involvement, multiple recurrences, positive surgical margins, or concurrent neck node metastasis. These factors are poor prognostic parameters and might mitigate the indications for aggressive salvage surgery. However, low recurrent T-stage tumor without neck metastasis carries a good prognosis. Modern minimally invasive surgery carries minimal morbidity.STUDY DESIGN A retrospective study was made to determine prognostic indicators in patients treated with salvage surgery for recurrent nasopharyngeal carcinoma.METHODS Medical records were analyzed for all patients who had received nasopharyngectomy for recurrent nasopharyngeal carcinoma from March 1997 to June 2001. They were followed up from March 1997 to January 2002. Recurrent T stage, nodal metastasis, surgical approach, surgical margins, and pathological nodal status, together with surgical mortality, morbidity, and the delivery of postoperative irradiation, were compared with survival.RESULTS In all, 43 patients underwent 45 nasopharyngectomies over a period of 4 years and 3 months. Patients with less than 1 year of follow-up were excluded. Four patients with residual disease, who represent a more favorable group, and five patients with planned debulking, nasopharyngectomy, and postoperative stereotactic irradiation were also excluded. The study group comprised 25 men and 6 women (ratio of 4:1) with age ranging from 26 to 69 years (mean age, 49.5 y). In 28 patients (90.3%), the recurrence of nasopharyngeal carcinoma was their first recurrence; in 3 patients (9.7%), the recurrences were second recurrences. Twenty-two patients (71%) survived, achieving a mean survival of 28.5 months. Nine patients died with a mean interval of 7.8 months (range, 1-14 mo). Of the nine patients who died, six (67%) had T3 or T4 tumor, four (44.4%) had concurrent recurrent neck disease, and five (55.5%) had positive surgical margins. Two patients died of perioperative meningitis. Fifteen (83.3%) of the 18 disease-free survivors had a low recurrent T-stage tumor. Mean intervals for development of repeat recurrence or distant metastasis were 16 and 7.9 months, respectively.CONCLUSIONS High recurrent T stage, skull base involvement, repeated recurrence before surgery, nodal metastasis, and positive surgical margins carry a poor prognosis. This is particularly evident with high T stage and concurrent nodal metastasis. However, patients with low T stage have a survival advantage and benefit most from surgical treatment.
机译：目的/假说鼻咽癌切除术是复发性鼻咽癌的一种行之有效的治疗选择。在4年3个月的时间里，总共43例患者进行了45例鼻咽癌切除术。研究了31例随访时间为12至58个月的患者。 22名患者（58％）存活;其中，有18名患者（82％）没有疾病。所有发生重复复发或死亡（n = 12）的患者均具有高复发性T期肿瘤，颅底受累，多次复发，手术切缘阳性或同时发生颈部淋巴结转移。这些因素是不良的预后参数，并可能减轻积极抢救性手术的适应症。然而，低复发性T期肿瘤无颈部转移预后良好。现代微创手术的发病率极低。研究设计回顾性研究确定了挽救性手术治疗复发性鼻咽癌的患者的预后指标。方法对1997年3月至1997年期间接受过鼻咽癌切除术的所有患者的病历进行分析。 2001年6月进行了随访，从1997年3月至2002年1月。将复发性T期，淋巴结转移，手术入路，手术切缘和病理性淋巴结状况以及手术死亡率，发病率和术后放疗情况与生存率进行了比较。结果总共有43例患者在4年零3个月内接受了45次鼻咽癌切除术。随访少于一年的患者被排除在外。还排除了4例残存疾病的患者，它们是较有利的一组，还有5例计划进行减重，鼻咽切除和术后立体定向照射的患者。该研究组由25位男性和6位女性（比例为4：1）组成，年龄从26岁到69岁（平均年龄49.5岁）。在28例患者中（90.3％），鼻咽癌的复发是他们的首次复发。 3例（9.7％）复发为第二次复发。 22名患者（71％）存活，平均存活28.5个月。 9名患者死亡，平均间隔为7.8个月（1-14个月）。死亡的9例患者中，有6例（67％）患有T3或T4肿瘤，其中4例（44.4％）患有并发性复发性颈部疾病，而5例（55.5％）的手术切缘阳性。两名患者死于围手术期脑膜炎。 18名无病幸存者中有15名（83.3％）患有低复发性T期肿瘤。结论复发性T远期或远处转移的平均间隔分别为16个月和7.9个月。结论高T期复发，颅底受累，术前反复复发，淋巴结转移和手术切缘阳性预后较差。这在高T期和同时的淋巴结转移中尤为明显。然而，低T期患者具有生存优势，并从手术治疗中受益最大。

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