经口机器人手术治疗扁桃体鳞癌的临床应用价值:中国五家中心病例分析  

Transoral robotic surgery of tonsillar squamous cell carcinoma:analysis of 157 cases from five medical centers

作　　者：陶磊 梁发雅[2] 陆翔 杨安奎[4] 周梁 张诠[4] 张星[4] 吴春萍 杨会军[5] 楚龙娟 何超 徐成志 陈镜涛 韩萍[2] 王琰[5] 黄晓明[2] 宋明[4] Tao Lei;Liang Faya;Lu Xiang;Yang Ankui;Zhou Liang;Zhang Quan;Zhang Xing;Wu Chunping;Yang Huijun;Chu Longjuan;He Chao;Xu Chengzhi;Chen Jingtao;Han Ping;Wang Yan;Huang Xiaoming;Song Ming(Department of Otolaryngology Head and Neck Surgery,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Otorhinolaryngology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510280,China;Department of Otorhinolaryngology Head and Neck Surgery,Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science&Technology,Wuhan 430030,China;Department of Head and Neck Surgery,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Otorhinolarygology,The First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科,上海200031 [2]中山大学孙逸仙纪念医院耳鼻咽喉科,广州510280 [3]华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科,武汉430030 [4]中山大学肿瘤防治中心头颈科,广州510060 [5]中国医科大学附属第一医院耳鼻咽喉科,沈阳110001

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第3期258-265,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨经口机器人手术(TORS)在扁桃体鳞状细胞癌(TSCC)治疗中的临床应用价值。方法采用回顾性分析方法,汇总中山大学肿瘤防治中心、中山大学孙逸仙纪念医院、复旦大学附属眼耳鼻喉科医院、中国医科大学附属第一医院以及华中科技大学同济医学院附属同济医院五个医疗中心在2017年1月1日至2022年7月31日接受TORS治疗且随访满2年的157例TSCC患者的临床资料(2年组),男性130例,女性27例,年龄24~85岁,其中随访满3年的患者99例(3年组)。分析患者的总生存期(OS)、无进展生存期(PFS)、临床分期、人乳头状瘤病毒(HPV)感染情况以及术后其他随访数据。使用IBM SPSS 25.0和SAS 9.4软件进行统计分析。结果针对整体数据,经TORS治疗的2年组OS率为91.7%,2年组PFS率为87.9%,3年组OS率为85.9%,3年组PFS率为82.8%。对于不同T分期,经TORS治疗的局部早期(T1-2期)患者预后比局部晚期(T3期)好,2年组OS率为94.4%比78.0%(P=0.005),2年组PFS率91.2%比75.0%(P=0.011),3年组OS率为91.1%比65.0%(P=0.004),3年组PFS率88.6%比60.0%(P=0.002);对于不同分期患者(Ⅰ-Ⅱ期比Ⅲ-Ⅳ期),3年组OS率为90.0%比79.5%(P=0.204),3年组PFS率86.7%比76.9%(P=0.188);对于不同HPV感染状态组,经TORS治疗后HPV阳性患者预后比HPV阴性好,3年组OS率为90.9%比80.5%(P=0.045),3年组PFS率90.9%比75.6%(P=0.047)。术后气管套管留置平均时间为25.1 d;术后鼻饲管留置率为94.3%(148/157),鼻饲管留置平均时间为8.5 d。结论TORS对TSCC患者的治疗具有突出的生存获益,HPV阳性TSCC患者对比HPV阴性者有更好的预后,TORS治疗TSCC患者对术后恢复以及生活质量的保障具有优势。ObjectiveTo explore the clinical application value of transoral robotic surgery(TORS)in the treatment of tonsil squamous cell carcinoma(TSCC).MethodsA retrospective analysis was conducted.The clinical data of 157 TSCC patients were collected who received TORS at five medical centers,namely,the Sun Yat-sen University Cancer Center,Sun Yat-sen Memorial Hospital,Eye Ear Nose and Throat Hospital of Fudan University,the First Affiliated Hospital of China Medical University,and Tongji Hospital of Tongji Medical College,from January 12017 to July 312022.There were 130 males and 27 females,aged 24-85 years.All patients were followed-up at least for 2 years(2-year group),among them,99 patients had a follow-up of 3 years(3-year group).The overall survival(OS),progression-free survival(PFS),clinical stage,human papillomavirus(HPV)infection status were analyzed.SPSS 25.0 and SAS 9.4 were used for statistical analysis.ResultsThe OS and PFS of the 2-year group were 91.7%and 87.9%,respectively.The OS and PFS of the 3-year group were 85.9%and 82.8%,respectively.The prognosis of patients with locally early-stage was better than that of locally advanced patients,with the OS of 94.4%for T1-2 vs.78.0%for T3(P=0.005)and the PFS of 91.2%for T1-2 vs.75.0%for T3(P=0.011)in the 2-year group;the OS of 91.1%for T1-2 vs.65.0%for T3(P=0.004)and the PFS of 88.6%for T1-2 vs.60.0%for T3(P=0.002)in the 3-year group;and also,the OS of 90.0%for stageⅠ-Ⅱvs.79.5%for stageⅢ-Ⅳ(P=0.204)and the PFS of 86.7%for stageⅠ-Ⅱvs.76.9%for stageⅢ-Ⅳ(P=0.188)in the 3-year group.The prognosis of HPV-positive TSCC patients was better than that of HPV-negative patients in the 3-year group,with the OS of 90.9%for HPV-positive vs.80.5%for HPV-negative(P=0.045)and the PFS of 90.9%for HPV-positive vs.75.6%for HPV-negative(P=0.047).The average time of postoperative tracheal cannula indwelling was 25.1 days.The indwelling rate and average indwelling time of the postoperative nasogastric tube were 94.3%(148/157)and 8.5 days,respectively.ConclusionTORS has out

关 键 词：扁桃体肿瘤 鳞状细胞癌 经口机器人手术 总生存期 无进展生存期 

分 类 号：R739.6[医药卫生—肿瘤]