High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma.
Adult
Aged
Aged, 80 and over
Disease-Free Survival
Female
Head and Neck Neoplasms
/ mortality
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Middle Aged
Prognosis
Recurrence
Retrospective Studies
Risk Factors
Salvage Therapy
/ methods
Squamous Cell Carcinoma of Head and Neck
/ mortality
Survival Rate
HNSCC
Head and neck cancer
Salvage surgery
Journal
Oral oncology
ISSN: 1879-0593
Titre abrégé: Oral Oncol
Pays: England
ID NLM: 9709118
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
09
07
2018
revised:
20
10
2018
accepted:
07
11
2018
entrez:
9
1
2019
pubmed:
9
1
2019
medline:
9
4
2020
Statut:
ppublish
Résumé
Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial. We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS). Median age at diagnosis was 61 years (range 40-86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004). Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.
Identifiants
pubmed: 30616803
pii: S1368-8375(18)30420-2
doi: 10.1016/j.oraloncology.2018.11.010
pmc: PMC6327963
mid: NIHMS1512846
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
9-15Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001426
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.
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