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Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection
Author(s) -
Liu YouPing,
Li Hao,
You Rui,
Li JiBin,
Liu XueKui,
Yang AnKui,
Guo Xiang,
Song Ming,
Zhang Quan,
Guo ZhuMing,
Chen WenKuan,
Liu WeiWei,
Zou Xiong,
Hua YiJun,
Yang Qi,
Zhang YiNuan,
Sun Rui,
Mo HaoYuan,
Guo Ling,
Lin AiHua,
Mai HaiQiang,
Qian ChaoNan,
Chen MingYuan
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27317
Subject(s) - nasopharyngeal carcinoma , neck dissection , medicine , surgery , carcinoma , dissection (medical) , radiation therapy , general surgery
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. Level of Evidence 4 Laryngoscope , 129:387–395, 2019