术前颈内动脉栓塞以优化复发性鼻咽癌挽救性内镜鼻咽切除术的肿瘤学与手术结局
Prior internal carotid artery embolization to optimize oncological and surgical outcomes in salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma.
文献信息
| PMID | 42873226 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | H Xu |
| 作者单位 | Department of otolaryngology-Head and Neck surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China. |
| 期刊 | Rhinology |
| SCI 分区 | Q1 |
| IF | 4.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 对于伴有颈内动脉（ICA）受累的复发性鼻咽癌（rNPC），挽救性内镜鼻咽切除术（SEN）存在灾难性出血和切除不完整的极高风险。本研究旨在评估术前ICA栓塞的有效性和安全性。
方法： 回顾性筛选了2006年1月至2022年12月期间接受SEN治疗的535例rNPC患者。在140例影像学显示ICA受累的患者中，经过预先设定的排除标准，确定了114例符合条件的患者。倾向性评分匹配（1:1）产生了50对均衡配对，比较接受术前ICA栓塞的SEN与单纯SEN。终点包括总生存期、无进展生存期、R0切除率以及治疗相关并发症的发生率。
结果： 与未栓塞组相比，栓塞组在无进展生存期（PFS）方面表现出统计学显著改善。虽然栓塞队列的总生存期（OS）显示出有利的临床趋势，但未达到统计学显著性。术前栓塞促进了显著更高的R0切除率，并大幅降低了致命性ICA破裂的发生率。游泳图分析显示，栓塞队列的疾病稳定期延长，对后续挽救治疗的应答增强。此外，该队列术后脑缺血的发生率较低，而其他治疗相关的一般不良事件往往更频繁，尤其是吞咽困难。
结论： 术前ICA栓塞是一种变革性且安全的辅助策略，可显著改善伴有ICA受累的rNPC患者的PFS和局部肿瘤控制。
英文摘要
UNLABELLED: BACKGROUND Salvage endoscopic nasopharyngectomy (SEN) for recurrent nasopharyngeal carcinoma (rNPC) with internal carotid artery (ICA) involvement carries prohibitive risks of catastrophic hemorrhage and incomplete resection. This study aims to evaluate the efficacy and safety of preoperative ICA embolization.
METHODS: Between January 2006 and December 2022, 535 patients who underwent SEN for rNPC were retrospectively screened. Among 140 patients with radiological ICA involvement, 114 eligible patients were identified after predefined exclusions. Propensity score matching (1:1) yielded 50 well-balanced pairs comparing SEN with preoperative ICA embolization versus SEN alone. Endpoints included overall survival, progression-free survival, R0 resection rate and the incidence of treatment-related complications.
RESULTS: The embolization group demonstrated a statistically significant improvement in progression-free survival (PFS) compared to the non-embolization group. While overall survival (OS) showed a favorable clinical trend for the embolization cohort, it did not reach statistical significance. Preoperative embolization facilitated a significantly higher R0 resection rate and drastically reduced the incidence of fatal ICA rupture. Swimming plot analysis revealed prolonged disease stability and enhanced responsiveness to subsequent salvage therapies in the embolization cohort. Additionally, this cohort exhibited lower incidence of postoperative cerebral ischemia, while other treatment-related general adverse events tended to be more frequent, especially in dysphagia.
CONCLUSION: Preoperative ICA embolization is a transformative and safe adjunctive strategy that significantly improves PFS and local oncological control for patients with rNPC involving the ICA.