☆ 4.5 Article

Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection

LARYNGOSCOPE (2019)

Journal

LARYNGOSCOPE

Volume 129, Issue 2, Pages 387-395

Publisher

WILEY

DOI: 10.1002/lary.27317

Keywords

Nasopharyngeal carcinoma; lymph node; recurrence; neck dissection; overall survival

Funding

National Natural Science Foundation of China [81572912]
Guangdong Public Welfare Research and Capacity Building Projects [2014B020212005]
Guangdong Provincial Natural Science Foundation in China [S2013020012726]
Program of Sun Yat-Sen University for Clinical Research 5010 Program [201310, 2015011]
Major Project of Sun Yat-Sen University for the New Cross Subject
Special Support Program for High-level Talents in Sun Yat-Sen University Cancer Center

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Abstract

Objective To compare survival effects of comprehensive neck dissection (CND) and selective neck dissection (SND) for patients with nasopharyngeal carcinoma (NPC) with only regional failure. Methods A total of 294 recurrent T0N1-3M0 NPC patients who underwent neck dissection in Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China, between January 1984 and February 2014, were enrolled in the survival and interaction analyses. Using propensity scores to adjust for potential prognostic factors, an additional well-balanced cohort of 210 patients was constructed by matching each patient who received SND with one patient who underwent CND (1:1); the differences were then compared between SND and CND in terms of overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS). Results Both univariate and multivariate analyses showed that SND was not inferior to CND (P > 0.05) but demonstrated that extracapsular spread (ECS) (hazard ratio [HR] 3.49, 95% confidence interval [CI] 2.30-5.29, P < 0.001), recurrent N stage (rN stage) (HR 1.96, 95% CI 1.29-2.97, P = 0.002), and positive margins (HR 3.67, 95% CI 2.40-5.62, P < 0.001) were independent poor prognostic factors for OS. The interaction effects between the dissection style and each independent factor were not significant for OS, LRFS, RRFS, or DMFS (P > 0.05). Furthermore, no survival differences were found between SND and CND in the case-matched cohort in terms of OS, LRFS, RRFS, or DMFS (P = 0.550, 0.930, 0.214, and 0.146, respectively). Conclusion With a similar radical dissection extent around the tumor rather than dissection of extensive lymph region distal to the lesion, SND is not inferior to CND for patients with NPC with only cervical failure. ECS, rN stage, and positive margins were adverse independent prognostic factors for patients with NPC.

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Transoral Robotic Retropharyngeal Lymph Node Dissection in Nasopharyngeal Carcinoma With Retropharyngeal Lymph Node Recurrence

Xi Ding, Qing-Guang Lin, Xiong Zou, You-Ping Liu, Yi-Jun Hua, Yu-Long Xie, Zhi-Qiang Wang, Yi-Nuan Zhang, Yang-Kui Gu, Rui You, Qi Yang, Meng-Xia Zhang, Si-Yuan Chen, Yan-Feng Ouyang, Zi-Kun Yu, Rui Sun, Ming-Yuan Chen

Summary: TORS-RPLND is a feasible, safe, and effective method for treating NPC patients with RPLN recurrence, especially when combined with intraoperative ultrasound positioning. The procedure resulted in en bloc resection in 8 out of 10 patients, with mild complications and a low rate of recurrence.

LARYNGOSCOPE (2021)