Objective: To investigate the feasibility of endoscopic salvage surgery for patients with rT2 recurrent nasopharyngeal carcinoma (rNPC) and to analyze their prognostic factors. Methods: The clinical data of 33 patients with rT2 rNPC who underwent endoscopic extended nasopharyngectomy in Eye & ENT Hospital Affiliated to Fudan University from January 2015 to July 2020 were analyzed, including 29 males (87.9%) and 4 females (12.1%), aging (51.7±10.6) years. The clinicopathological characteristics of these patients were recorded and analyzed, in terms of gender, sex, alcohol and cigarette use, interval between primary treatment to recurrence, adjuvant therapy, lymph node metastasis, internal carotid artery (ICA) invasion, necrosis, margin and reconstruction materials. Kaplan Meier analysis was used to plot the overall survival rate and progression free survival rate curve, Log-rank test was used to analyze the prognostic factors among patients, and multivariate Cox proportional hazards regression was used to determine the independent risk factors of tumor progression free survival. Results: Among 33 patients with rT2 rNPC, the recurrence interval of 24 patients with rNPC after primary radiotherapy was more than 2 years. A total of 25 patients received primary radiotherapy and adjuvant chemotherapy at the same time. There were 6 cases with cervical lymph node metastasis, 12 cases with ICA invasion, 8 cases with positive surgical margin, 7 cases underwent ICA embolization before operation. A total of 18 cases underwent pedicled tissue flap repairment after operation, including 12 pedicled nasal septal mucosa flaps and 6 temporalis muscle flaps. The median follow-up time was 15 months. Five patients died because of disease progression (in 2 cases), post surgical ICA hemorrhage (in 1 case), liver metastasis (in 1 case) and dysphagia (in 1 case). The 1-year, 2-year and 3-year overall survival rates of all patients were 93.9%, 81.8% and 81.8%, respectively. The 1-year, 2-year and 3-year progression free survival rates were 74.7%, 59.7% and 40.9%, respectively. Log-rank statistical analysis showed that the positive surgical margin (P=0.060) and recurrence interval (P=0.151) were possibly related to the prognosis of rT2 rNPC. Multivariate Cox regression analysis showed that the positive surgical margin was an independent risk factor for patients with rT2 rNPC (P=0.034). Nasopharynx hemorrhage occurred in 4 patients, skull base bone necrosis occurred in 2 patients, trismus occurred in 3 patients, and no obvious brain complications occurred in 7 patients with ICA embolization. Conclusion: Endoscopic salvage surgery for rT2 rNPC is a safe and effective surgical option, but the long-term effect still needs long-term follow-up in bulk cases.
目的： 探讨内镜下挽救性手术治疗rT2期复发性鼻咽癌（recurrent nasopharyngeal carcinoma，rNPC）的可行性，并对其预后进行分析。 方法： 回顾性分析2015年1月至2020年7月于复旦大学附属眼耳鼻喉科医院行内镜下扩大鼻咽切除术治疗的33例rT2期rNPC患者的临床资料，其中男性29例（87.9%），女性4例（12.1%），年龄（51.7±10.6）岁。记录分析不同性别、年龄、吸烟史、饮酒史、复发间隔时间、辅助化疗、淋巴结转移、颈内动脉侵犯、肿瘤坏死情况、手术切缘和带蒂黏膜瓣/肌肉瓣使用情况等的临床病理特点。通过Kaplan-Meier曲线绘制总体生存率和无肿瘤进展生存率曲线，Log-rank检验分析患者的预后因素，多因素Cox比例风险回归确定无肿瘤进展生存期的独立危险因素。 结果： 33例rT2期rNPC患者中，24例在初发鼻咽癌放疗后复发间隔时间超过2年，25例初次放疗同时接受辅助化疗，6例存在颈部淋巴结转移，12例存在颈内动脉侵犯，7例术前行颈内动脉栓塞，8例手术切缘阳性。18例患者术后采用带蒂组织瓣修复颅底，其中带蒂鼻中隔黏膜瓣12例，颞肌瓣6例。中位随访时间15个月，共5例患者死亡，死亡原因包括局部肿瘤进展2例、术后颈内动脉出血1例、肝脏转移1例、进食困难1例。所有患者的1、2、3年总体生存率分别为93.9%、81.8%和81.8%，1、2、3年无肿瘤进展生存率分别为74.7%、59.7%和40.9%。Log-rank统计分析显示手术切缘阳性（P=0.060）和复发间隔时间（P=0.151）有可能影响rT2期rNPC的预后。多变量Cox回归分析发现手术切缘阳性是影响rT2期rNPC患者的独立危险因素（P=0.034）。术后4例患者出现鼻咽部出血，2例患者出现鼻咽部坏死，3例患者出现张口受限，7例行颈内动脉栓塞的患者术后均未出现明显脑部并发症。 结论： 内镜下挽救性手术治疗rT2期rNPC是一种安全、有效的手术治疗方式，但远期疗效仍需大宗病例的长期随访。.