放化疗后浅表性头颈癌内镜喉咽手术相关的不良事件风险及预后因素
Adverse event risks and prognostic factors associated with endoscopic laryngopharyngeal surgery for superficial head and neck cancer after chemoradiotherapy.
文献信息
| PMID | 42762422 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Sakiko Naito |
| 作者单位 | Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1, Nishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. rin.sooooo.sweety@gmail.com. |
| 期刊 | International journal of clinical oncology |
| SCI 分区 | Q3 |
| IF | 3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 内镜喉咽手术（ELPS）是浅表性头颈鳞状细胞癌（sHNSCC）的器官保留治疗。虽然ELPS在原发性和异时性病变中显示出良好结局，但其作为放化疗（CRT）后挽救治疗的作用仍不明确。我们评估了挽救性ELPS的临床结局以及与不良事件（AEs）和预后相关的因素。
方法： 在2014年至2024年间接受ELPS的136例患者中，我们回顾性分析了17例CRT后诊断为sHNSCC的患者。患者被分为挽救组和异时组，并比较了临床特征、治疗结局、AEs和生存。
结果： 整块切除率为100%。47.1%的患者发生AEs，且挽救组比异时组更频繁（70.0% vs. 14.3%，p=0.024）。体重指数（BMI）<18.5 kg/m2与AEs显著相关（p=0.043）。4年总生存（OS）在两组间无显著差异（83.3% vs. 71.4%），而12个月无复发生存率在挽救组倾向于更低（68.6% vs. 85.7%）。BMI也与OS相关：BMI ≥18.5 kg/m2的患者4年OS为81.8%，而BMI <18.5 kg/m2的患者为50%（p=0.036）。
结论： sHNSCC的挽救性ELPS与更高的AE风险相关，但显示出与异时性ELPS相当的长期生存结局。营养状态，特别是低BMI，是安全性和预后的关键决定因素。这些发现支持ELPS作为器官保留策略的可行性，并强调在挽救性治疗中仔细选择患者和进行营养评估的重要性。
英文摘要
BACKGROUND: Endoscopic laryngopharyngeal surgery (ELPS) is an organ-preserving treatment for superficial head and neck squamous cell carcinoma (sHNSCC). While ELPS shows favorable outcomes in primary and metachronous lesions, its role as salvage treatment following chemoradiotherapy (CRT) remains unclear. We evaluated the clinical outcomes of salvage ELPS and factors associated with adverse events (AEs) and prognosis.
METHODS: Among 136 patients undergoing ELPS between 2014 and 2024, we retrospectively analyzed 17 diagnosed with sHNSCC following CRT. Patients were categorized into salvage and metachronous groups, and clinical characteristics, treatment outcomes, AEs, and survival were compared.
RESULTS: The en bloc resection rate was 100%. AEs occurred in 47.1% of patients and were more frequent in the salvage group than in the metachronous group (70.0% vs. 14.3%, p=0.024). Body mass index (BMI) <18.5 kg/m2 was significantly associated with AEs (p=0.043). 4-year overall survival (OS) did not differ significantly between groups (83.3% vs. 71.4%), while 12-month relapse-free survival tended to be lower in the salvage group (68.6% vs. 85.7%). BMI was also associated with OS: patients with BMI ≥18.5 kg/m2 had a 4-year OS of 81.8%, compared with 50% for patients with BMI <18.5 kg/m2 (p=0.036).
CONCLUSION: Salvage ELPS for sHNSCC was associated with a higher AE risk but showed long-term survival outcomes comparable to metachronous ELPS. Nutritional status, particularly low BMI, is a key determinant of safety and prognosis. These findings support the feasibility of ELPS as an organ-preserving strategy and emphasize the importance of careful patient selection and nutritional assessment in salvage settings.