经口机器人手术在口咽鳞癌治疗中的临床价值  

The clinical value of oral robotic surgery in the treatment of oropharyngeal squamous cell carcinoma

作　　者：张星[1] 杨中元[1] 杨安奎[1] 张诠[1] 李秋梨[1] 陈树伟[1] 陈镜涛 宋明[1] Zhang Xing;Yang Zhongyuan;Yang Ankui;Zhang Quan;Li Qiuli;Chen Shuwei;Chen Jingtao;Song Ming(Department of Head and Neck Surgery,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]华南肿瘤学国家重点实验室肿瘤医学协同创新中心中山大学肿瘤防治中心头颈外科,广州510060

出　　处：《中华肿瘤杂志》2022年第6期570-576,共7页Chinese Journal of Oncology

摘　　要：目的探讨经口机器人手术(TORS)和传统手术在口咽鳞癌中的治疗效果。方法回顾性分析2010—2018年于中山大学肿瘤防治中心治疗口咽鳞癌患者的临床病理资料, 135例经传统手术方式治疗(非TORS组), 52例经TORS治疗(TORS组)。生存分析采用Kaplan-Meier法和Log rank检验, 影响因素分析采用Cox回归模型。结果 TORS组患者2年生存率(94.2%)和2年无进展生存率(93.8%)均优于非TORS组(分别为71.4%和71.4%, 均P<0.05)。TORS组T1~2期患者2年生存率(93.3%)和2年无进展生存率(92.8%)均优于非TORS组(分别为73.1%和72.8%, 均P<0.05)。TORS组Ⅰ~Ⅱ期患者2年生存率(95.8%)和2年无进展生存率(95.2%)与非TORS组(分别为84.1%和83.9%)比较, 差异无统计学意义(均P>0.05)。TORS组Ⅲ~Ⅳ期患者2年生存率(92.9%)和2年无进展生存率(92.7%)均优于非TORS组(分别为64.7%和63.9%, 均P<0.05), TORS组人乳头状瘤病毒(HPV)阳性患者2年生存率(94.4%)与非TORS组HPV阳性患者(83.3%)比较, 差异无统计学意义(P=0.222)。TORS组HPV阴性患者2年生存率(94.1%)与非TORS组HPV阴性患者(43.7%)比较, 差异有统计学意义(P<0.001)。HPV状态是患者预后的独立影响因素(P=0.008)。结论与传统治疗模式比较, TORS治疗的口咽鳞癌患者有更优的预后, 尤其是局部早期T1~2患者, 经TORS治疗后能有更好的生存获益;HPV阳性口咽鳞癌患者比HPV阴性口咽鳞癌患者有更好的预后, 且无论HPV状况如何, TORS组患者都能获得更好的生存预后。Objective To explore the therapeutic effects of transoral robotic surgery(TORS)and traditional surgical modes in oropharyngeal squamous cell carcinoma(OPSCC).Methods The clinicopathological data of patients with oropharyngeal squamous cell carcinoma treated at Sun Yat-sen University Cancer Center from 2010 to 2018 were retrospectively analyzed.135 cases were treated with traditional surgery(non-TORS group),while 52 cases were treated with TORS(TORS group).The prognosis of the two groups of patients were analyzed by Kaplan-Meier method and Log rank test,the influencing factors were analyzed by Cox regression model.Results The 2-year overall survival(OS,94.2%)and 2-year progression-free survival(PFS,93.8%)of patients in the TORS group were better than those in the non-TORS group(71.4%and 71.4%,respectively,P<0.05).The 2-year OS(93.3%)and 2-year PFS(92.8%)of TORS group patients in T1-2 stage were better than those of non-TORS group(73.1%and 72.8%,respectively,P<0.05).The 2-year OS(95.8%)and 2-year PFS(95.2%)of patients with stageⅠtoⅡin the TORS group were not significantly different from those in the non-TORS group(84.1%and 83.9%,respectively,P>0.05).The 2-year OS(92.9%)and 2-year PFS rate(92.7%)of patients with stageⅢtoⅣin the TORS group were better than those in the non-TORS group(64.7%and 63.9%,respectively,P<0.05).The 2-year OS(94.4%)of HPV-positive patients in the TORS group was not significantly different from that in the non-TORS group(83.3%,P=0.222).The 2-year OS of HPV-negative patients in the TORS group(94.1%)was significantly different from that in the non-TORS group(43.7%,P<0.001).HPV status was an independent prognostic factor(P=0.008).Conclusions TORS has a better prognosis in the treatment of oropharyngeal squamous cell carcinoma compared with the traditional treatment methods.The patients with T1-T2 can achieve better survival benefits after TORS treatment.The HPV-positive OPSCC patients has a better prognosis than that of HPV-negative OPSCC patients,and regardless of HPV status,OPSCC patient

关 键 词：口咽鳞癌 达芬奇经口机器人手术 人乳头瘤病毒 总生存 无进展生存 

分 类 号：R739.63[医药卫生—肿瘤]