新辅助化学免疫治疗联合经口机器人手术治疗局部晚期口咽鳞癌的初步疗效  

Preliminary outcomes of neoadjuvant chemoimmunotherapy combined with transoral robotic surgery for locally advanced oropharyngeal squamous cell carcinoma

作　　者：陈仁辉[1,2] 梁发雅 韩萍[1,2] 林沛亮 林惜君[1,2] 王静怡 孔祥炜 黄晓明 Chen Renhui;Liang Faya;Han Ping;Lin Peiliang;Lin Xijun;Wang Jingyi;Kong Xiangwei;Huang Xiaoming(Department of Otolaryngology,Head and Neck Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510280,China;Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation,Guangzhou 510280,China)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉头颈外科,广州510280 [2]广东省恶性肿瘤表观遗传与基因调控重点实验室,广州510280

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第4期329-334,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广州市地区临床高新、重大和特色技术项目(重大项目)(2023P-ZD13)。

摘　　要：目的探讨新辅助治疗联合经口机器人手术(transoral robotic surgery,TORS)治疗局部晚期口咽鳞状细胞癌(简称鳞癌)的初步疗效。方法回顾性分析中山大学孙逸仙纪念医院耳鼻咽喉头颈外科2019年4月至2023年2月,新辅助治疗后行TORS的15例局部晚期口咽鳞癌病例,其中男性12例,女性3例,年龄31~74岁。扁桃体癌12例,舌根癌3例;Ⅲ期11例,Ⅳ期4例。新辅助化学治疗2例,新辅助化学联合免疫治疗13例;疗程为2~3周期,均经多学科会诊通过后进行TORS。总结临床病理学特点、手术及肿瘤学结果。结果手术均顺利完成,病理切缘均阴性,无中转手术病例。患者术后均鼻饲饮食,胃管停留中位时间为7 d(范围:2~60 d);无气管切开病例,无术后出血等严重并发症。13例行新辅助化学免疫治疗病例中,10例(76.9%)术后病理完全缓解。随访时间中位数为21个月(范围:10~47个月),无死亡及远处转移病例,1例rT0N3M0扁桃体癌患者在术后5个月发生局部复发。15例患者2年总生存率为100.0%,2年无病生存率为93.3%。结论新辅助治疗联合TORS为局部晚期口咽鳞癌患者提供一种有效且微创的治疗方法。Objective To evaluate the efficacy of neoadjuvant chemoimmunotherapy(NACI)combined with transoral robotic surgery(TORS)in the treatment of locally advanced oropharyngeal squamous cell carcinoma(OPSCC).Methods This was a retrospective study of 15 patients with locally advanced OPSCC who underwent TORS after neoadjuvant therapy(NAT)at the Department of Otolaryngology-Head and Neck Surgery of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2019 to February 2023.There were 12 males and 3 females,aged 31 to 74 years.Twelve cases were tonsil cancer,and 3 cases were tongue base cancer.There were 11 cases in stageⅢand 4 cases in stageⅣ.Two patients received neoadjuvant chemotherapy and 13 patients received NACI,with 2 to 3 cycles,and all patients underwent TORS after multidisciplinary team consultation.The clinicopathological characteristics,surgical outcomes,and oncological results were summarized.Results All surgeries were successfully completed with negative surgical margins,and no case was required conversion surgery.All patients were fed via nasogastric tubes postoperatively,with a median gastric tube stay of 7 days(range:2-60 days).No tracheotomy was applied.There were no major complications such as postoperative bleeding.Pathological complete response(pCR)was found in 10 cases(76.9%)among the 13 patients with NACI.The follow-up time was 21 months(range:10-47 months),and there was no death or distant metastasis.One patient with rT0N3M0 tonsil cancer had local recurrence 5 months after surgery.The 2-year overall survival and 2-year disease-free survival were respectively 100.0%and 93.3%in the 15 patients.Conclusion NACI combined with TORS provides a safe,effective and minimally invasive treatment for patients with locally advanced oropharyngeal squamous cell carcinoma.

关 键 词：口咽肿瘤 癌 鳞状细胞 经口机器人手术 新辅助治疗 化学治疗 免疫治疗 

分 类 号：R739.63[医药卫生—肿瘤]