舌腺癌晚期的治疗策略：多中心REFCOR研究

Therapeutic strategy for advanced stages salivary carcinomas of the tongue: A multicenter REFCOR study

ORAL ONCOLOGY

影响因子:3.9

分区:医学2区 / 牙科与口腔外科2区肿瘤学3区

发表日期:2024 Dec

作者: Valentine Poissonnet, Emilien Chabrillac, Emmanuelle Uro-Coste, Virginie Woisard, Antoine Moya-Plana, Florent Espitalier, Joel Castelli, Thibault Dedieu, Sébastien Salas, Renaud Garrel, Robin Baudouin, Gilles Poissonnet, Claire Castain, Jonathan Barbut, Haitham Mirghani, Diane Evrard, Olivier Bouchain, Jean Paul Marie, Hélène Orliac, Philippe Ceruse, Xavier Dufour, Esteban Brenet, Audrey Rambeau, Philippe Herman, Yazan Abu Shama, Chloé Bertolus, Sarah Atallah, Sylvain Morinière, Christian Righini, François Mouawad, Suzy Duflo, Bertille Segier, Sébastien Vergez

DOI: 10.1016/j.oraloncology.2024.107072

摘要

舌腺癌是治疗上的一大挑战，因为其根治性切除极具破坏性。我们旨在研究晚期舌腺癌的肿瘤学和功能学结局。本回顾性多中心研究基于法国罕见头颈肿瘤网络（REFCOR），包括2009年1月至2018年12月期间诊断的所有T3-T4期舌腺癌患者。共纳入47例患者，其中44.7%接受了手术。肿瘤组织多为腺样囊性癌（61.7%），其次是其他腺癌（27.7%）和粘液表皮样癌（10.6%）。中位随访时间为63.9个月。在多变量分析中，手术与更好的无复发生存率（HR=0.23，95% CI [0.09;0.55]）及局部/区域复发无生存率（HR=0.31，95% CI [0.10;0.95]）显著相关。随访结束时，远处转移发生率在手术组为61.9%，非手术组为57.7%。远处转移无病生存率为54.9%（38.3%至68.7%），两组间无统计学差异。两组在完全胃造口术率相似，但在最后随访时，手术组的正常口腔进食比例似乎更高（38.1%对比15.4%）。该人群的根治性手术主要旨在改善局部/区域控制，可能带来更好的长期吞咽功能。大约一半的肿瘤在初诊时伴有隐匿性远处转移。未来需要更多研究以明确术后放疗和同步化疗非手术治疗的作用。

Abstract

Salivary carcinomas of the tongue represent a therapeutic challenge as their radical excision is particularly mutilating. We aimed to study the oncologic and functional outcomes of advanced stages salivary carcinomas of the tongue.This retrospective multicentric study, based on the French national network on rare head and neck cancers (REFCOR), included all patients with a T3-T4 salivary carcinoma of the tongue, diagnosed between January 2009 and December 2018.In total, 47 patients were included, of which 44.7 % underwent surgery. Histologies were mostly adenoid cystic carcinomas (61.7 %), followed by other adenocarcinomas (27.7 %) and mucoepidermoid carcinomas (10.6 %). Median follow-up duration was 63.9 months. In multivariable analysis, surgery was significantly associated with better Recurrence-Free Survival (HR = 0.23, 95 %CI [0.09;0.55]) and Local/Regional Recurrence-Free Survival (HR = 0.31, 95 %CI [0.10;0.95]). The rate of distant metastasis at the end of follow-up was 61.9 % in the surgical group and 57.7 % in the non-surgical group. The Distant Metastasis Free Survival was 54.9 % [38.3;68.7], without statistical difference between both groups. There were similar rates of definitive gastrostomies but the rate of normal oral diet at the last follow-up seemed higher in the surgery group (38.1 % vs 15.4 %).Radical surgery in that population mainly aims to improve local/regional control, which may result in better long-term swallowing functions. About half of these tumors may be associated with occult distant metastasis at initial presentation. More studies are warranted to establish the role of postoperative RT and non-surgical treatment with concurrent CRT.